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ARE MEDICAL THEORIES OBJECTIVE?

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CAN MEDICAL THEORIES BE OBJECTIVE?
By

Zahra Iqbal Meghani

A DISSERTATION

Submitted to
Michigan State University
In partial fulﬁllment of the requirements
for the degree of

DOCTOR OF PHILOSOPHY
Department of Philosophy

2006

ABSTRACT

ARE MEDICAL THEORIES OBJECTIVE?

By
Zahra Iqbal Meghani

Are medical theories objective? Christopher Boorse and Tristram Engelhardt,
two well-regarded philosophers of medicine, offer radically different responses to that
question. Boorse appears to be committed to the idea that medical theories can, in
principle, provide objective accounts of the medical conditions at issue. Englehardt, in
contrast, has argued that medical theories cannot avoid being laden with social and
political values because they reﬂect human attempts to correlate a variety of

phenomena for the social purposes of explanation, prediction, and control.

Although both philosophers' arguments are interesting, neither one's analysis is
satisfactory. I believe Boorse's position is ﬂawed because it is based on an uncritical
commitment to the logical-positivist conception of objectivity. While Engelhardt does
not make that mistake, I contend that the argument that he gives in support of his
stance (that all theories of disease are normative) is weak. A key goal of this
dissertation is to remedy the shortcomings of Boorse's and Engelhardt's analyses. To
that end, I analyze and critique the concept of objectivity that is based on the logical-
positivist epistemology. I construct an alternative account of objectivity that is
informed by actual human knowledge-building practices. Amongst other things, my
notion of objectivity includes strategies that could be used to identify the social,

ethical, and political values shaping medical theories about particular conditions.

Copyright by
ZAHRA IQBAL MEGHANI
2006

DEDICATION

With many thanks to A.

In appreciation of my parents, brothers, and my grandfather.

iv

ACKNOWLEDGMENTS

With many, many thanks to Jim Nelson and Hilde Lindemann for supporting me and
affording me opportunities during my graduate career. Moreover, with many thanks to
Jim Nelson and Fred Gifford for working with me on numerous draﬁs. Also, with

thanks to Andrew Shail, Rita Gallin, and Laura Landolt for their guidance.

TABLE OF CONTENTS

CHAPTER ONE
1.1 A Brief Sketch of The Problem Motivating
The Dissertation ............................................................................. 1
1.2 A Road Map to The Rest of The Dissertation ................................ 6
CHAPTER TWO
2.0 Introduction .................................................................................. 1 7
2.1 The Logical-Positivist Conception of Scientiﬁc
Objectivity as Embodied in Hempel's Work ................................ 17
2.2 Helen Longino’s Critique of the Logical Positivist
Conception of Objectivity ............................................................ 19
2.3 Limitations and Strengths of Longino’s Analysis ........................ 28
2.4 Setting-Up Lynn Hankinson Nelson’s Critique of
the Logical-Positivist Conception of Objectivity ........................ 32
2.5 Quine on Ordinary Language Metaphysics,
Science, and Values ...................................................................... 33
2.6 Nelson’s Critique of the Logical-Positivist Conception
of Objectivity ............................................................................... 37
2.7 Strengths and Limitations of Nelson’s Analysis .......................... 44
2.8 An Alternative Notion of Objectivity .......................................... 53
CHAPTER THREE
3.0 Introduction .................................................................................. 60
3.] Williams Obstetrics' Menstruation-as-Pathological-
Evolutionary-Aberration Theory ................................................. 60
3.2 Short’s Menstruation-as Pathological-Evolutionary-
Aberration Theory ........................................................................ 61
3.3 Scrutinizing the Cultural Context of Short Et Al.’s
Theorizing Using Marginalized Perspectives .............................. 69
3.4 Coutinho and Segal's Menstruation-as-Pathology
Theory .......................................................................................... 74
3.5 Coutinho and Segal's Iron-Deﬁciency Anemia and
PMS Arguments ........................................................................... 75
3.6 Examining the Cultural and Institutional Context of
Coutinho and Segal's Theory Using Marginalized
Perspectives ................................................................................. 82
3.7 Conclusion ................................................................................... 92
CHAPTER FOUR
4.0 Introduction ................................................................................. 95
4.1 Boorse's Deﬁnition of Disease and His Account of
Theories of Diseases .................................................................... 95
4.2. Boorse’s Possible Response to Short‘s,

Williams Obstetrics', and Segal-Coutinho's
Menstruation-as-Pathology Theories .......................................... 98

vi

4.3 The Signiﬁcance of My Notion of Objectivity for
Boorse's Account of Theories Of Diseases And

His (Possible) Assessment Of Short Et Al.'s Theories .............. 100
4.4 Engelhardt's Conception of Disease and His Account
of Theories of Diseases ............................................................. 104

4.5 Engelhardt's Possible Response to Short's, Williams

Obstetrics', and Segal-Coutinho's Menstruation-

as-Pathology Theories ................................................................ 110
4.6 The Signiﬁcance of My Notion of Objectivity for

Engelhardt's Account of Theories Of Diseases And

His (Possible) Assessment Of Short EtA1.'s Theories ............... 111
4.7 Conclusion ................................................................................. 1 13
CHAPTER FIVE
5.0 Introduction ................................................................................ 1 15
5.1 Critiques of Medical Theories from the Perspective
of the Socially Marginalized ...................................................... 115
5.2 The Critical Insight Objection .................................................... 118
5.3 My Response to the Critical Insight Objection .......................... 119
5.4 The Epistemic Privilege Objection ............................................ 124
5.5 My Response to the Epistemic Privilege Objection .................. 125
5 .6 Conclusion ................................................................................. 130
BIBLIOGRAPHY .............................................................................................. 139

vii

CHAPTER ONE

1.1 A Brief Sketch of The Problem Motivating The Dissertation

Are medical theories, say about ulcers or the pre-menstrual syndrome,
objective? In other words, do understandings of the phenomena that are categorized as
diseases, syndromes, or disorders incorporate the social, ethical, or political values and
concerns of medical theorists and their societies? Or are they determined solely by the
relevant facts about nature, which are independent of any person's or community's
social, ethical, or political values?

Christopher Boorse and Tristram Engelhardt, two well-regarded philosophers
of medicine, offer radically different responses to that question. Boorse appears to be
committed to the idea that medical theories can, in principle, provide objective
accounts of the medical conditions at issue. Englehardt, in contrast, has argued that
medical theories cannot avoid being laden with social and political values because
they reﬂect human attempts to correlate a variety of phenomena for the social
purposes of explanation, prediction, and control.

Although both philosophers' arguments are interesting, neither one's analysis is
satisfactory. I believe Boorse's position is ﬂawed because it is based on an uncritical
commitment to the logical-positivist conception of objectivity. While Engelhardt does
not make that mistake, I contend that the argument that he gives in support of his
stance (that all theories of disease are normative) is weak. A key goal of this
dissertation is to remedy the shortcomings of Boorse's and Engelhardt's analyses. To
that end, I analyze and critique the concept of objectivity that is based on the logical-

positivist epistemology. I construct an alternative account of objectivity that is

informed by actual human knowledge-building practices. Amongst other things, my
notion of objectivity includes strategies that could be used to identify the social,
ethical, and political values shaping medical theories about particular conditions.
Thus, I radically re-conﬁgure the ground conditions for future discussions in
philosophy of medicine about the objectivity of medical theories.

Besides critiquing the answer that philosophers of medicine might give to the
question about the objectivity of medical theories, I also assess the response that
medical theoristsl might give to that question, "can medical theories be objective?". In
all likelihood, their response to that question will be a resounding "Yes." Their answer
must be understood in light of their continued commitment to the logical-positivist
conception of objectivity. Logical-positivists, such as Carl Hempel, claimed that
objectivity of science and theories was assured by requiring inter-subjective
conﬁrmation of evidence cited in support of particular hypotheses. That belief appears
to be premised on the assumption that the process of intersubjective veriﬁcation (or
loosely speaking, peer review) of the evidence (given in support of a particular
hypothesis) ﬁlters out claims tainted with the idiosyncratic beliefs and values of
theorists. That occurs, presumably, because, ﬁrst, not all of the peer reviewers would
subscribe to those particular values, and thus, they would reject claims loaded with
values. And second, claims that are laden with social, ethical, and political values
cannot be empirically veriﬁed; thus, the peer reviewers would reject such claims as
well. The logical positivist notion of objectivity held sway in the sciences and in

medicine during the 20th century and appears to reign even today.

 

IBy the term "medical theorists" 1 mean all persons involved in constructing and testing medical
theories.

In recent years, philosophers of science, such as Helen Longino and Lynn
Hankinson Nelson, have formulated particularly compelling critiques of the logical-
positivist notion of objectivity. Using a number of scientiﬁc theories as case studies,
Longino has argued that the logical-positivist conception of objectivity cannot
guarantee value-free theories because it does not control for social, ethical, and
political values that may be embedded in background assumptions mediating the
relationship between evidence and hypotheses, and thus, could be inﬂuencing the
shape of the scientiﬁc theories.2 Nelson, in tandem, has made the case that the logical-
positivists failed to recognize that scientists are part of the larger social order, which
both permits and shapes their work, and thus, science cannot be regarded as
autonomous from the values of that community.3

Unfortunately, philosophers of medicine, such as Boorse and Engelhardt, and
medical theorists do not appear to have been attentive to these developments in
philosophy of science and epistemology, and thus, their response to the question "Are
medical theories objective?" are uninformed. The aim of this dissertation is to address

that oversight in the following two ways:

1. By constructing an argument that demonstrates that Longino's and Nelson's
critique of the logical-positivist conception of objectivity has relevance for
medicine and philosophy of medicine.

2. By correcting the ﬂaws in Longino's and Nelson's critique of the logical-

positivist conception of objectivity and using their analysis to construct an

 

2Longino 1993 and 2001.
3Nelson 1990.

alternative notion of objectivity that will be of use to philosophers of medicine

and medical theorists as they assess particular medical theories.

My engagement with the issue of the objectivity of medical theories reﬂects my
interest in bioethics, philosophy of science, and epistemology. I bring recent
developments in epistemology and philosophy of science (regarding the nature of
knowledge building activities) to bear on the answer that philosophers of medicine
and medical theorists may give to the question about the objectivity of medical
theories. I do so to demonstrate that epistemology and philosophy of science can offer
medicine and philosophy of medicine crucial analyses and critiques about their
commitments and practices. That would enable them to be disciplines that are much
more self-reﬂective than they are currently.

In the remainder of this chapter, I outline the logical-positivist conception of
objectivity. In the second chapter, I give a detailed account of Helen Longino’s and
Lynn Hankinson Nelson’s analysis of the logical-positivist notion of objectivity,
followed by a critique of their work. Then, I formulate a notion of objectivity that is a
viable alternative to the logical positivist one. In chapter three, I use my conception of
objectivity to bring to light some of the values that motivate, are embedded in, and
espoused by two recent medical theories about monthly menstruation. In chapter four,
I argue that ChristOpher Boorse's and Tristram Engelhardt's ability to identify the
social and political values embedded in the two menstruation theories is limited.
Boorse is compromised because of his (unacknowledged) commitment to the logical
positivist notion of objectivity. While Engelhardt does not make that mistake, his

position is weak because, among other things, he does not provide any strategies for

identifying social and political values shaping medical theories (this is a shortcoming
of Boorse as well). I argue that by adopting my conception of objectivity their
assessment of medical theories, including the two menstruation-as-pathology theories,
would be informed by actual human epistemic practices and their analyses would be
more sensitive to the values shaping medical theories than they are capable of being as
they stand now. In the ﬁfth and ﬁnal chapter, I identify and respond to two objections
to my notion of objectivity.

As I have now mapped out the road I travel in the course of the dissertation,
the remainder of this chapter is a prelude to that journey. I begin by outlining the
logical-positivist conception of objectivity, then, I sketch the critique of this paradigm
that has been formulated by various epistemologists and philosophers of science, with
special attention to Helen Longino's and Lynn Hankinson Nelson's work. I focus on
them because, ﬁrst, they have developed substantive critiques of the logical-positivist
conception of objectivity that are directly relevant to my project. And second, I use
their analyses of gender biased scientiﬁc theories to guide me as I critique the two
sexist theories that medicalize menstruation (I use those two theories to demonstrate
the efﬁcacy of one of the strategies 1 develop for identifying social and political values
shaping medical theories). Thus, their work has an edge for my purposes that is not
there in the works of other critics of the logical positivist epistemology.

After that, I argue that by taking to heart my notion of objectivity, philosophers
of medicine may be able to formulate a fairly robust conception of the epistemic
responsibilities of medical theorists. That notion of epistemic responsibility would call
on medical theorists to create theoretical accounts of women's and men's physiology

that are informed by actual human epistemic practices as opposed to ones that are

uninformed about them (by virtue of being based on the logical-positivist notion of
objectivity). I close the chapter by acknowledging that although philosophers of
medicine may come to see the wisdom of rejecting the logical-positivist conception of

objectivity, they may still have reservations about adopting my notion of objectivity.

1.2 A Road Map to The Rest of The Dissertation

As a philosophical movement, the development of the logical-positivist
empiricist epistemology was a reaction to the heavily metaphysical, non-empirical
theorizing of the 19th century. During the 20th century, the logical-positivist
epistemology became deeply embedded in the natural and social sciences as well as in
medicine. It remains entrenched within these disciplines even today. Although, in
some of the social sciences, such as sociology, a number of theorists have rejected that
epistemic paradigm,4 that is not the case in medicine. One would be hard pressed to
ﬁnd a medical textbook whose editors are aware that they owe their methodology,
especially their notion of objectivity, to logical—positivism.

The success of that epistemology in establishing itself in the sciences and in
medicine is attributable to the political and social events of the 20th century. The
founders and proponents of logical-positivism were physicists, mathematicians and
philosophers of science, such as Hempel, Carnap, Reichenbach, and F eigl. After
ﬂeeing Europe to escape persecution from Nazis, they came to occupy prominent and
inﬂuential positions at some of the more prestigious higher education institutions in

the United States and on the editorial boards of leading academic journals. Thus

 

4Longino has identiﬁed sociologists Steven Shapin (1982), Barry Barnes, and David Bloor (1982) as
theorists who have rejected the logical positivist epistemology (Longino, Fate of Knowledge, 13-22).

situated, they were able to give shape to academic inquiry in mathematics, physics,
and philosophy. I also believe the logical-positivist epistemic paradigm was adopted
by the social sciences and medicine because the empiricist approach advocated by it
was already very much a part of these disciplines. The success of logical-positivism
may also, in part, be attributable to the fact that it was introduced to a society that, at
the beginning of the 20th century, was already committed to empiricism because it
was the approach that was responsible for major technological advances.

The founders and proponents of logical—positivism were interested in
empirically veriﬁable knowledge about the world, which they believed could only be
provided by testable claims.5 In the interest of systematically acquiring and
accumulating such knowledge, they marked the sciences as a domain exclusively
constituted of veriﬁable claims. Hempel writes, “Science aims at a
comprehensive body of sound empirical knowledge, represented by a body of well-
conﬁrmed (read: inter-subjectively veriﬁed) system of empirical statements. . .”6 Non-
empirically veriﬁable claims, be they metaphysical or value claims, were to have no
place in theories.

The interest of the logical-positivists in empirically veriﬁable claims had much
to do with their theory of meaning. According to logical-positivists, there were two
sorts of meaningful sentences. A meaningful sentence was one that was true or false
by virtue of its form (i.e., tautologies and contradictions). Or a meaningful sentence
was one that was either itself empirically veriﬁable or empirically veriﬁable by means

of “deductive (i.e., syntactical) relations which the sentence [in question] [bore] to

 

5 Hempel, “Valuation and Objectivity in Science” in The Philosophy of Carl G. Hempel, 2001, 376.
6 Hempel, Philosophy of Natural Science, 40.

some ﬁnite set of protocol sentences, whose truth values are themselves determinable
by direct observation.”7

Rudolf Carnap has argued that all metaphysical claims were meaningless. He
categorized metaphysical claims as pseudo-statements. Pseudo-statements fell into two
categories; one, statements that contained words that were held to be meaningful but
were not. And two, statements whose “constituent words are meaningful, yet they are
put together in a counter-syntactical way, so that they do not yield a meaningful
statement.”8

Sentences employing metaphysical terms such as “the Absolute” qualiﬁed as
pseudo-statements of the ﬁrst sort because they failed to meet the criteria for
meaningfulness by containing a word that was not meaningful. For the logical-

positivists, a word, say “b,” 9 used in an elementary sentence, say “S(b),” qualiﬁed as

meaningful if it met the following four criteria:

1. “The empirical criteria for b are known.

2. It has been stipulated from what protocol sentences “S(b)” is deducible.
3. The truth-conditions for “S(b)” are ﬁxed.

4. The method of verification of “S(b) is known.”10

 

7 Joseph Hanna, "The Logic of ZOm-Century Empiricism." The Heritage of Logical Positivism ed.
Nicholas Rescher. 1985. 37.

8 Carnap, Rudolf. I996. "Elimination of Metaphysics." Logical Empiricism at Its Peak : Schlick.
Carnap, and Neurath (Science and Philosophy in the Twentieth Century: Basic Works of Logical
Empiricism) ed Sahotra Sarkar, II.

9 Although Carnap used ‘a' instead of ‘b’ to refer to some word, in the interest of clarity 1 made the
substitution.

'0 Carnap, "Elimination of Metaphysics," 14-15.

The other sort of pseudo-statements were meaningless because even though they were
constituted of meaningful terms, the conjunction of these terms resulted in claims that
were not empirically veriﬁable.ll As an example of such a claim, Carnap gave the
following sentence from Heidegger’s Was 1st Metaphysik?'2: "Does the Nothing exist
only because the Not, i.e., the Negation, exists?"'3 The problem with such questions
was that there was no way of empirically verifying any imaginable answer to them.
On the basis of this theory of meaning, Carnap concluded that metaphysical

claims as well as value claims were meaningless:

Logical analysis, then, pronounces the verdict of meaninglessness on any
alleged knowledge that pretends to reach above or behind experience. This
verdict hits, in the ﬁrst place, any speculative metaphysics, any alleged
knowledge by pure thinking or by pure intuition that pretends to be able to do
the kind of metaphysics which, starting from experience, wants to acquire
knowledge about that which transcends experience by means of special
inference (e. g. the neo-vitalist thesis of the directive presence of an “entelechy”
in organic processes, which supposedly cannot be understood in terms of
physics; the question concerning the ‘essence of causality,’ transcending the
ascertainment of certain regularities of succession; the talk about the ‘thing in
itself’). Further, the same judgment must be passed on all philosophies of
norms, or philosophy of value, on any ethics or esthetics as a normative

discipline. For the objective validity of a value or norm is (even on the view of

 

” Carnap, "Elimination of Metaphysics," 18.

l2Carnap does not provide the page number for this quote from the 1929 edition of Was lst Metaphysik?
'3 It is worth noting that while Carnap uses the quoted bit from Heidegger to argue that the claims made
by idealist philosophers were non-veriﬁable, the quote that he uses is a question and not a claim. Of
course that does not discount the point that Carnap was making. I owe this point to Professor 1. Nelson.

the philosophers of value) not empirically veriﬁable nor deducible from
empirical statements; hence it cannot be asserted (in a meaningful statement) at
all. In other words: Either empirical criteria are indicated for the use of ‘good’
and ‘beautiful’ and the rest of the predicates that are employed in the
normative sciences, or they are not. In the ﬁrst case, a statement containing
such a predicate turns into a factual judgment, but not a value judgment; the
second case, it becomes a pseudo-statement. It is altogether impossible to make

a (meaningful) statement that expresses a value judgment.”

Although metaphysical and value claims did not qualify as descriptive statements
about states of affairs (because they were not veriﬁable), they functioned as
“expressions of the general attitude of a person toward life.”ls
Given that the logical-positivists believed value claims were meaningless
claims that were only expressive of a person’s general attitude toward life, it is
unlikely that they would tolerate the presence of social and political values in theories.
In fact, Carnap made it clear that value claims had no place in science when he
declared: “We (i.e., the logical positivists) take the view, expressed already by Hume,
that besides logico-mathematical tautologies (analytic sentences), science contains
only the empirical sentences of the factual sciences (cf.n.1).”'6 Scientiﬁc theories that

included value claims would be a morass of meaningful and meaningless sentences,

marring any attempt to know the world. '7 Their assumption that scientiﬁc theories

 

‘1 Carnap, "Elimination of Metaphysics," 26-7.

'5 Carnap, R. "Elimination of Metaphysics," 28.

'6 Carnap, R. "The Task of The Logic of Science." Uniﬁed Science ed Brian McGuinness.

l“'Although the logical positivists objected to the presence of value laden claims in the theory proper,
they were not opposed to values determining which scientiﬁc projects were pursued and how scientiﬁc
knowledge was used (more on this later).

could be and should be value-neutral is problematic for reasons that will be discussed
below.

Another related problematic feature of the logical-positivist position of interest
to my project is the epistemic assumption that observation claims were not laden with
theory or values. Joseph Hanna has argued that the logical-positivists believed the aim
of science, unlike that of other disciplines, was the effective resolution of all
professional disagreements.18 The assumption underlying this conception of science
was that (with enough work) effective decision procedures could be constructed to
resolve any disputes between researchers, including discrepancies in observation
statements.19 That assumption was based on the unjustiﬁed supposition that
observation claims were not laden with theory or values (more on this below).

The third problematic aspect of the logical-positivist epistemology relevant to
the purposes of this dissertation is its commitment to the idea (embodied in CC.
Hempel’s Studies in The Logic of Conﬁrmation) that just by looking at hypotheses and
evidence claims, any theorist “could determine in a rule governed way the observation

”20 According to Helen

reports that would conﬁrm the hypothesis (in question).
Longino, the assumption here is that the relationship between hypotheses and evidence
claims is relatively straightforward, devoid of any complicating background
assumptions, including background assumptions laden with contextual values. (She

uses the term "contextual values" to signify "social, ethical, and political values."2')

 

'8 Hanna, Joseph. "The Logic of 20th-Century Empiricism," in The Heritage of Logical Positivism by
Nicholas Rescher, 48.
'9 Disputes that were not amenable to this approach were, presumably, metaphysical issues and not the
gurview of scientiﬁc inquiry.

Longino, Helen. Science as Social Knowledge (SSK), p. 25.
2'She contrasts those values with constitutive values. Constitutive values are epistemic values of
theories, such as simplicity, explanatory scope, predictive success, etc.

11

Longino contends that this assumption is not justiﬁed; below I lay out her critique of
this epistemic assumption.

In the last four decades, the various features of the logical-positivist
epistemology delineated above have come under heavy ﬁre. Thomas Kuhn22 and
Norwood Russell Hanson23 have argued that one’s observations conﬁrming or
disconﬁrming one’s theory are colored by one’s theoretical commitments. On the
basis of their work, Hanna has argued that the logical-positivists were not justiﬁed in
assuming that observation statements were not value-laden. In fact, he critiques
Carnap’s views on the grounds that he fails to engage with the underlying problem of
the value-ladenness of observation statements.24

Presumably building on that critique, Helen Longino25 contends that the
logical-positivists were not justiﬁed in assuming that the process of developing and
verifying hypotheses could be rendered value-free by implementing protocols that
barred the subjective value preferences of individual practitioners from intruding on
scientiﬁc inquiry. She argues that norms could inﬂuence theorizing in the form of
value laden background assumptions mediating the hypotheses-evidence relationship
(the background assumptions would be encoded with contextual values). The larger
goal of her critique is to call into question the logical-positivist assumption that all
scientiﬁc theories could be denuded of social, ethical, and political values.

A number of feminist theorists have argued that the notion of the ideal
epistemic agent underlying logical-positivism is deeply ﬂawed. Lynn Hankinson

Nelson has developed the idea that community membership in the larger social order

 

22 Kuhn, Thomas. The Structure of Scientiﬁc Revolutions.
23 Hanson, N.R. Patterns of Discovery

2‘ Carnap, “Empiricism, Semantics, and Ontology.”

2’ Longino, ssx, p. 20-25 and 38-52.

12

is a necessary pre-condition for knowing, and therefore, the larger social order, and
not just scientiﬁc communities, qualify as epistemic communities. Thus, she
challenges the logical-positivist assumption that scientists can detach themselves from
the concerns of the larger social order in their work and that science can be
autonomous from social, ethical, and political values.

While Longino’s and Nelson’s critique is directed at scientiﬁc theorizing that
is based on the logical-positivist conception of objectivity, it has direct relevance for
philosophy of medicine and medicine. Medical theorists, like the logical-positivists,
appear to believe that there can be value-neutral theories, i.e., theories that do not
contain or are not shaped by social, ethical, or political values.26 They seem to hold
that the practice of intersubjective veriﬁcation of hypotheses (or more loosely
speaking, peer review) controls for those claims that contain contextual values. For
instance, R.V. Short has theorized that monthly menstruation is a pathological
evolutionary aberration that requires treatment in the form of menstrual suppressant
contraceptives (I discuss his work at length in chapter three). He, presumably,
considers his work to be objective because the network of hypotheses constituting his
theory has been intersubjectively veriﬁed.

I believe if philosophers of medicine took to heart the notion of objectivity I
formulate (using Longino's and Nelson's analysis of logical-positivism), their ability to
'see' the values shaping medical theories would be enhanced (I discuss this issue at
length in chapter four). Moreover, by adopting my notion of objectivity, they would be
able to formulate a fairly robust account of the epistemic responsibilities of medical

theorists. I contend objectivity is a way of engaging with the world that requires,

 

26In chapter two, I discuss at length the issue of values inﬂuencing or being encoded in theories.

l3

amongst other things, recognizing that all theories are laden with contextual values
and that all knowledge building enterprises are communal activities. It also means
responding appropriately to criticism.27 Using my notion of objectivity, philosophers
of medicine will be able to argue that medical theorists who recognize that their work
is a value-laden activity will be more self-aware and self-critical than those, like Short,
who labor under the illusion that their work is objective in the traditional (logical-
positivist) sense. That may result in medical theories that generate representations of
human physiology that are better than the ones that have been constructed so far. For
instance, it may result in theories about women's reproductive physiology that are
better than those that have been formulated by implicitly holding up men's
reproductive physiology as the paradigm case.

In speaking of a better representation of human reproductive physiology, I do
not mean to commit myself to the idea that it is possible for humans to attain an
epistemic perspective about women's and men's physiology that is unmediated by any
political, ethical, or social values. But I do believe there are better and worse
representations of human physiology. There are at least three criteria that could allow
one to judge between competing representations. They are as follows: ﬁrst, how well a
particular representation maps on to the world relative to other empirically adequate
theoretical models.28 For instance, if a particular representation of women’s
reproductive physiology asserted that women in this society menstruate on a bi-
monthly cycle; such a representation would have to be judged worse than one that

claimed that women menstruate roughly on a monthly cycle. The second criterion that

 

27In chapter two, 1 provide a detailed account of my notion of objectivity.

2" The notion of theories as models that map on to the world is borrowed from Ronald Giere and Helen
Longino. See chapter ﬁve for a discussion of the theory of theories as model (or maps) that reﬂect the
particular interests and concerns of those constructed them.

14

could help discriminate between better and worse representation of human physiology
has to do with the purpose that the theorizing is supposed to serve in a particular
social context. If theories of women's reproductive physiology are meant to foster their
well-being, then it is dubious that a theoretical model of women’s reproductive
physiology that is mediated by a patriarchal assumptions serves that purpose well (the
cases I discuss in chapter three illustrate this point).29 The third criterion that could
help distinguish between better and worse accounts of human physiology has to do
with the purpose that a particular theory actually serves (as opposed to the purpose
that those who created it claim it serves). For instance, in the case of a theory that
relies on sexist assumptions to medicalize women’s periodicity (but whose creators
claim to be motivated by a concern for women's well being), it could be argued that it
serves patriarchal purposes by construing women as inherently defective relative to
men, and thus, it should be rejected in favor of a theory that is not complicit in the
oppression of women.

In the interest of identifying the social, ethical, and political values shaping
particular medical theories, I contend theorists ought to invite and respond
appropriately to criticism of their work from members of marginalized groups. I
espouse that strategy because various feminist epistemologists and philosophers of
science (including some of those discussed above”) have cogently argued that by

virtue of their peripheral social loci, disenfranchised groups are better able to identify

 

29Elaine Showalter, for instance, has argued that the medicalization of species typical aspects of
women’s biology has allowed patriarchal societies to categorize women who have rebelled against
oppressive practices as pathological, neatly side stepping any moral responsibility toward these victims
of social injustice. (Showalter, Elaine. The Female Malaafy: Women, Madness, and the English Culture,
1830.1980. Penguin, 1987).

3° Longino, SSK and “Essential Tensions- Phase Two: Feminist, Philosophical, and Social Studies of
Science,” and Sandra Harding, ls Science Multicultural? Postcolonialisms, F eminisms, and
Epistemologies.

15

oppressive values shaping theorizing than members of the scientiﬁc community, many
of whom occupy a position of privilege in various societies.3 '

But some philosophers of medicine may have reservations about that strategy.
They could object that, ﬁrst; my proposal appears to be based on the unjustiﬁed
assumption that all members of the marginalized group will have critical insight about
theory under scrutiny. Second, my proposal is impractical because different
disenfranchised groups may offer competing analyses of the theory under
consideration but I have not offered a method that medical theorists could use to
adjudicate between them.32 Thus, medical theorists would not know which one of the
competing analyses they should use to revise their theories or deﬁne future research
agendas. In the ﬁfth and ﬁnal chapter of my dissertation, I discuss these objections
and respond to them.

Having mapped out my project, in the next chapter, I discuss Helen Longino’s
and Lynn Hankinson Nelson’s analysis of the logical-positivist notion of objectivity.

On the basis of their work, I also formulate an alternative to the logical-positivist

notion of objectivity.

 

3' This is not to say all members of marginalized groups by virtue of their membership in non-dominant
communities will necessarily be critical of the dominant paradigm. Various standpoint theorists have
argued that only those who are critical of the account of reality provided by the oppressive dominant
paradigm justifying its practices are the ones whose insights should be privileged over that of those who
have uncritically accepted the dominant paradigm, even though both parties might be members of
marginalized communities.

37’1” his objection has been leveled against standpoint theory. I discuss it at length in chapter ﬁve.

16

CHAPTER TWO

2. 0 Introduction

In this chapter, I formulate an alternative to the logical-positivist notion of
objectivity.33 My conception of objectivity is informed by Helen Longino’s and Lynn
Hankinson Nelson’s analysis of logical positivism. I begin by delineating the logical-
positivist conception of objectivity. Then, in turn, I describe and assess Longino's and
Nelson's analyses. 1 close the chapter by articulating a new notion of objectivity and

discussing its signiﬁcance for the question motivating the dissertation.

2.1 The Logical-Positivist Conception of Objectivity as Embodied in Hempel's
Work

Carl Hempel articulated a vision of the sciences as an activity which “aim[ed]
at a comprehensive body of sound empirical knowledge, represented by a body of
well-conﬁrmed systems of empirical statements. . 3’34 It is because the logical
positivists believed that social, ethical, and political values were not empirically
veriﬁable that they held that such (contextual) values ought not be part of scientiﬁc
theories in the sense of being embedded in the concepts, principles, hypotheses claims,
or observation claims of theories. But they did not oppose values inﬂuencing scientiﬁc
inquiry in other respects. Hempel, for instance, did not object if the decision to pursue
a particular ﬁeld, project, problem, or method of investigation rather than some other

one was based on social, ethical, and political concerns. Morever, he was not opposed

 

”In chapter four, I use my conception of objectivity to critique Boorse and Engelhardt.
3"Hempel, Philosophy of Natural Science (PNS), 40.

I7

to the decision to make use of scientiﬁc knowledge in certain ways as opposed to
others being made on normative grounds.35 Hempel also did not appear to be averse to
the idea that individual practitioners' subjective values and beliefs might play a role in
the context of theory discovery.36

In the interest of preventing contextual values of individual practitioners from
being encoded in the theories themselves (i.e., in the concepts, principles, evidence
claims, or hypothesis claims of theories), Hempel sought to develop a protocol that
could guarantee objective theories.37 He attempted to formulate the hypotheses-
evidence relationship in purely formal terms such that just by looking at hypotheses
and observation claims, without reference to the subject matter, one would be able to
tell whether or not the evidence in question conﬁrmed or disconﬁrmed the hypotheses
under consideration.38 Hempel seemed to assume that hypotheses and evidence that
satisﬁed that constraint would be free of "idiosyncratic beliefs and attitudes on the

part of the scientiﬁc investigators,"39

and thus, the objectivity of the theory in question
would be assured.40 Elaborating on that notion of objectivity, Hempel said, “science
aims at knowledge that is objective in the sense of being intersubjectively veriﬁable,
independently of individual opinion or preference, on the basis of data obtainable by

suitable experiments or observations.”4|

 

35Hempel, “Valuation and Objectivity in Science,” (VOS) 372-3.

3'SAs an example of the role that values could play in 'the context of theory discovery', Hempel notes
that Kepler's theory of planetary motions "... was inspired by his interest in a mystical doctrine about
numbers and a passion to demonstrate the music of spheres" (Philosophy of Natural Science, (PNS)
16). Hempel also recognized and considered it appropriate that epistemic norms, such as theoretical
simplicity, predictive prowess, accuracy, and explanatory scope, were used by the scientiﬁc community
to assess competing theories.

37Hempel, "Science and Human Values," (SHV) 46.

”Hempel, "Studies in the Logic of Conﬁrmation," (SLC) 10.

39Hempel, vos, 374.

”Hempel, PNS, I6, and vos.

“Hempel, 1965, 141. Emphasis in original. Hempel argues that even Carnap can be read as being
committed to this conception of objectivity. He gives Carnap this reading in the interest of defending

l8

2.2 Helen Longino ’s Critique of the Logical Positivist Conception of Objectivity
Longino's critique begins by noting that Hempel’s aim (in “Studies in the

Logic of Conﬁrmation” in articulating the concept of conﬁrmation and that of dis-

conﬁrmation) was to provide a formal characterization of the hypotheses-evidence

relationship without reference to the subject matter of the hypotheses or evidence:

For Hempel one ought to be able to tell simply by looking at the logical form
of a hypothesis sentence and an evidence sentence whether the conﬁrmation
relation holds between them, just as one can tell simply by inspecting the
logical forms of premise sentences and conclusion sentences whether the
implication relation holds between them. The search, then, is for formal
syntactic criteria of conﬁrmation analogous to the formal criteria for the

validity of deductive arguments.“

Longino gives two arguments against Hempel’s attempt to conceptualize the
hypotheses-evidence relationship in purely formal terms. I call these arguments the No
Shared Predicate Argument and the Background Assumption Argument.

The No Shared Predicate Argument takes Hempel’s critique of the inductivists
and uses it against him. Hempel argues that the inductivists’ claim that hypotheses are
formulated by being inductively inferred from observations was not justiﬁed because

observations statements and hypotheses sentences do not necessarily contain common

 

the logical-positivist conception of scientiﬁc objectivity against the charge of epistemic atomism and
relativism. According to Hempel, Carnap justiﬁed his theory of rational credibility of empirical
hypotheses by appealing to intersubjective agreement about the matter (Hempel, VOS, 380-1).

4 Longino, Science as Social Knowledge (SSK), 23.

19

terms.43 He used the atomic theory of matter to instantiate his argument. Evidence
claims for the atomic theory of matter contain claims about “cloud chambers, lines
observed in spectographic analysis, et cetera,”44 while hypotheses sentences refer to
atoms, neutrinos, quarks. Therefore, the inductivists were not warranted in making the
claim that hypotheses are derived by inductive inference from observations claims.

Longino uses Hempel’s argument against the inductivist to discredit his
attempt to articulate the evidence-hypotheses relationship in purely formal terms with
the end of ensuring the objectivity of theories. She contends that Hempel’s assumption
that the hypotheses-evidence relationship could be articulated in formal terms, without
reference to their subject matter of the hypotheses or evidence claims, is unwarranted.
As not all hypotheses sentences and evidence sentences share common terms, the

hypotheses-evidence relationship cannot be formalized:

The implication of this state of affairs (i.e., Hempel’s analysis of the inductivist
position) are, however, equally devastating for Hempel’s analysis of
conﬁrmation, if intended as a description of evidential relation. The analysis he
provides is of a formal, syntactic relation between sentences. This relation
holds only between sentences containing the same predicates: the development
of a hypothesis for a class contains only those predicates occurring in the
hypothesis, and as an observation report only conﬁrms a hypothesis if it entails
its development for the class of objects mentioned in the observation report, it

too must contain at least one of the predicates occurring in the hypothesis. That

 

”Longino, SSK, 24.
“Longino, SSK, 24.

20

is, the conﬁrmation relation as Hempel conceives it makes the same impossible

demand upon science as does the inductivist conception.45

Longino’s Background Assumption argument builds on the No Shared Predicate
argument. It faults Hempel’s conception of the hypotheses-evidence relationship on
the grounds that it assumes there is a necessary and unique relation between
hypotheses and evidence, unmediated by background assumptions. Longino argues
that that is not the case as the relationship between hypotheses and evidence may be
mediated by background assumptions. Moreover depending on one’s background
assumptions, one could read differently the same state of affairs, i.e., evidence.
(Longino uses the term “background assumptions” variously to mean interests, point
of view, or theory.) To make her case about the relevance of background assumptions
in shaping one's reading of the evidence, she gives a variety of non-scientiﬁc and
scientiﬁc examples. As an example of the non-scientiﬁc sort, she gives the case of two
men who enter a friend’s house and see a gray hat on a banister. Depending on their
background assumptions (in this case, their belief about who owns a gray colored hat
and who is inclined to leave it on the banister), the presence of the hat qua evidence
means different things to them.46 Longino also gives another example. She claims that
one’s reading of the presence of red spots on a child’s stomach is colored by one’s
background assumption. A person's whose background assumption is that stomach
rashes are a symptom of gastric disorder will not read the red spots on a child's
stomach in the same way as a person who subscribes to the background assumption

that they are indicative of measles.

 

"Longino, SSK, 24-5.
“Longino, SSK, 42-3.

21

Longino also faults Hempel's conception of the hypotheses-evidence
relationship on the grounds that it assumes that the relationship between hypotheses
and evidence is not mediated by background assumptions that are laden with
contextual (i.e., social, ethical, and political values -be they of individual practitioners
or those of a particular group). Depending on the value laden background assumptions
mediating between hypotheses and evidence, one could read same state of affairs (i.e.,
evidence) very differently.47 For the purposes of this chapter, I brieﬂy lay out her
analysis of a recent research project on the biological basis of gender role differences.

Behavioral endocrinologists Anke Ehrhardt and Heino Meyer-Bahlburg (1981)
have theorized that difference in gender role behavior are signiﬁcantly determined by
fetuses’ exposure to sex hormones.48 This theory is anchored in their research on girls
with Congenital Adrenocortical Hyperplasis (CAH).49 Ehrhardt and Meyer-Bahlburg
hypothesized that greater than normal exposure to androgen as fetuses causes these
females to exhibit “tomboyish” behavior. As evidence they cited the correlation
between girls with CAH and “tomboyish” behavior. On the basis of their research on
CAH girls and drawing on cases in other mammalian species, for examples, rats,
where behavior is hormonally determined,50 Erhardt and Meyer-Bahlburg theorize that
prenatal exposure to sex hormones “importantly inﬂuences” gender role behavior in
the human species.5 '

Besides critiquing Erhardt and Meyer-Bahlburg for using loaded language (for

example, “tomboyish”) in their study and not taking into account that their evidence

 

"Longino, SSK, 46-8.

4"Longino, SSK, 119.

49CAI-I is a condition marked by higher than statistically normal production of androgen during female
fetal development (Longino, SSK, l 14).

”There is good evidence that rodents exposed as fetuses to higher than normal levels of androgen
exhibit more aggressive behavior than they would otherwise.

“Longino, SSK, 119.

22

(i.e., the reports about the “tomboyish” behavior of CAH girls by the girls themselves
and their parents and teachers) might be problematically inﬂuenced by the observers’
expectations,52 Longino contends that the relationship between their hypothesis (about
CAH girls) and the evidence that they cite in support of it is mediated by background
assumptions of which they appear to be unaware. The background assumption in
question is the model of the brain that assumes that there is an uni-directional, causal
relationship between behavior and brain structure and chemistry. Longino argues that
if Erhardt and Meyer-Bahlburg had instead worked with an alternative model of the
brain that recognized both agent intentionality and interaction between agents and
their environment (along with brain structure and physiology) as determinants of
human behavior, it is unlikely that they would draw as strong a causal connection
between prenatal exposure to sex hormones and gender role behavior as they have
done.

Longino argues that not only is the relationship between hypotheses and
evidence mediated by background assumptions, some of those assumptions may be
laden with contextual values. For instance, the two models rely on different
"metaphysical assumptions about causality and human action," which, presumably,
have different attendant social, ethical, and political commitments and entailments.53
The model that draws a strong uni-directional relationship between brain structure and
physiology is committed to a form of biological determinism. Longino does not
believe that such a model recognizes the possibility of agency and intentionality, thus,

she argues, it limits our sense of ourselves as autonomous entities. Alternatively, the

 

”Longino notes that there are numerous other problems with this research project including the fact that
these theorizers are taking a very small population (which is non-representative of the larger human
population) along with data about another less complex species than humans, in this case, rats, to
generalize about a fairly complex phenomenon like gender role differences in humans.

Longino, SSK, 161.

23

model that allows for agency, interaction between agents and their enviroment, and
biology as deterrninates of behaviors conﬁrms our sense of ourselves as capable of
acting autonomously and intentionality. Longino also argues that given that equally
compelling evidence could be found in support of either theory of the brain, and
assuming that both theories have the same epistemic merits, and supposing that one
would not want to decide between them in a ﬂippant manner (say, by ﬂipping a coin),
the decision to support one or the other would have to be made on the basis of the
contextual values encoded in them.54

Thus, Longino challenges the logical positivist assumption that if the evidence
in support of a particular hypothesis was intersubjectively veriﬁable, the non-
nonnativity (i.e., objectivity) of their inquiry was assured. Her analysis demonstrates
that the logical positivists failed to take into account the possibility that contextual
values, embedded in the background assumptions mediating the hypotheses-evidence

relationship, could be inﬂuencing theorizing:

Background assumptions are the means by which contextual values and
ideology are incorporated into scientiﬁc inquiry. While not all such
assumptions encode social values, their necessity to evidential reasoning
means that the basic components of methodologies - logic and observation- are

not sufﬁcient to exclude values from proper inquiry (my italics).55

(It should be noted that Longino has not argued that all background assumptions

contain contextual values; she is conceding that there are background assumptions that

 

“Longino, SSK, 161
”Longino, SSK, 216.

24

do not encode social or political values (see italicized phrase in above quote). I discuss
that concession below.)

Believing that she has done serious damage to the logical-positivist of
objectivity, Longino offers an alternative account of scientiﬁc objectivity. She argues
that the type of scrutiny that allows science to lay claim to being objective is not the
kind that purports to identify and cleanse theories of any particular scientist’s
subjective preferences. Rather what allows science to lay claim to being objective is
the inter-subjective scrutiny of theories by the larger epistemic community. That
scrutiny exposes the contextual values encoded in theories in the form of value-laden
background assumptions, concepts, and claims. It also brings to light non-value laden
background assumptions. Longino’s account of scientiﬁc objectivity does not require
that all contextual values that are identiﬁed as encoded in theories be eliminated.
Rather she calls for the elimination of oppressive values shaping theorizing and
research such that science becomes an emancipatory practice. Longino argues that to
attempt to eliminate all contextual values from theories may “severely truncat[e] the
explanatory ambitions of science” because values importantly motivate and give shape
to human inquiry.56 The choice of the model of the brain in the case of the study of the
biological basis of gender role differences, for instance, is indicative of the potential
contextual values have for expanding and molding theorizing and research projects.

Scientiﬁc objectivity for Longino entails that there are publicly recognized

forums for the critique of evidence, hypotheses, methodology and inference. She also

 

”T he case of the two competing theories of the brain that are mediated by metaphysically charged
background assumptions illustrate this point. Longino, SSK, 223.

25

claims that objectivity requires that the scientiﬁc community not only tolerates dissent
but responds appropriately to criticism (more on this in chapter ﬁve).57

In the interest of identifying contextual values encoded in theories, Longino
advocates that scientists ought to engage in a critical dialogue about their work with
marginalized groups, such as feminists. I believe that proposal is premised on the idea
that by virtue of their social marginality, disenfranchised groups are more likely to
'see' the dominant social, political, and ethical values encoded in theories than those
who occupy positions of privilege. Members of the dominant group are less likely to
'see' the dominant values embedded in theories because by virtue of their position of
social privilege they have less reason (than those at the margins of society) to question
why society is set up the way it is and to question the dominant norms, practices, and
customs.58

While Longino endorses critical dialogue between the disenfranchised and
scientists, she makes it clear that only those marginalized communities that would be
willing to assess theories on the basis of their epistemic merits (as well as their
contextual values) should be at the table. In particular, she appears to be interested in
including feminists in this dialogue because of their commitment to an emancipatory

agendas9 She opposes the presence of "crackpot” marginalized groups, say

‘crystalogists’ or creationists at the table.60 The failure of such groups to meet the core

 

”Longino, SPK, 273 and SSK, 76-81.

58 The assumption is that members of the scientiﬁc community occupy a position of privilege in
Western societies vis-a-vis members of marginalized groups. This is not to say that there is no overlap
between the two.

”I attribute that position to her because Longino identiﬁes feminists as a group that she would want at
the table and she identiﬁes feminism as being at core about "expanding human potential" (Longino,
SSK, 190) and committed to opposing oppression.

“Longino (SPK, 118) in Feminist Epistemologies edited by Linda Alcoff and Elizabeth Potter.
Routledge. 1993.

26

standards of scientiﬁc inquiry warrants excluding them from the “knowledge-
constructive dialogue” (more on this in chapter ﬁve)“

Thus, in arguing for this conception of objectivity, Longino is, in effect,
arguing for an inter-subjective conception of objectivity that goes beyond identifying
and eliminating the subjective preferences of particular scientists. It means identifying
all contextual values embedded in theories- whether they are the social, ethical, and
political values of individual practitioners or that of a certain group- and ideally,
developing those theories that are consistent with the community's social, ethical, and

political values.

We cannot restrict ourselves simply to the elimination of bias but must expand
our scope to include the detection of limiting interpretative frameworks62 and
the ﬁnding or construction of more appropriate frameworks... Instead of
remaining passive with respect to the data and what the data suggest, we can,
therefore, acknowledge our ability to affect the course of knowledge and
fashion or favor research programs that are consistent with the values and

commitments we express in the rest of our lives.63

Longino's conception of scientiﬁc objectivity is at odds with that of the logical-

positivists; the latter would consider any encroachment of social or political values on

theories as compromising the objectivity of science.64

 

6' However, she acknowledges that this may not be a foolproof standard (Longino, “Subject, Power, and
Knowledge,” (SPK, 118) in Feminist Epistemologies).

621 read Longino to mean "theories" when she uses the phrase "interpretative frameworks."

63Longino, SSK, 191.

6" However, (as discussed earlier in section 2.1.1.) this is not to say that logical-positivists did not
recognize that the decision to pursue a particular project rather than some other one and the decision to

27

2.3 Limitations and Strengths of Longino ’s Analysis

Longino's critique is fairly compelling but it is not a categorical refutation of
the logical positivist ideal of objectivity. As I noted in the previous section, she argues
that some of the background assumptions that mediate the hypotheses-evidence
relationship of scientiﬁc theories may be value laden. That leaves open the possibility
that not all background assumptions are value-laden. She writes that while
"background assumptions are the means by which contextual values and ideology are
incorporated into scientiﬁc inquiry not all such assumptions encode social values
(my italics)."65 In acknowledging that not all background assumptions are laden with
social or political values, Longino allows for the possibility that there could be some
theories that are free of such values. Such theories would be ones that contain
background assumptions that are not laden with social, ethical and political norms
(assuming, of course, that contextual values are not present in those theories in other
ways that the logical positivists would consider unacceptable).

Longino's concession is signiﬁcant. It may embolden those of the logical
positivist persuasion to argue that their ideal of value free scientiﬁc theorizing ought
not be abandoned. Hempel, for instance, might claim that all contextual values
encoded in background assumptions should be identiﬁed and eliminated. Better
epistemic protocols than the current ones should be developed to prevent theories from
being corrupted by any contextual values, including culturally pervasive contextual
values that might be encoded in background assumptions. In fact, he might even
appropriate her strategy of engaging with marginalized groups to identify culturally

dominant values that might be ingrained in background assumptions. His aim would

 

make use of scientiﬁc knowledge in certain ways as opposed to other ways did not entail value
'udgments. (Hempel, SHV, 46).
SLongino, SSK, 215-6.

28

be to identify such assumptions and to replace them with background assumptions that
are not tainted by values, with the end of constructing theories that were free of
contextual values. Longino's argument that theories should not be denuded of all
contextual values because that might severely limit the explanatory goal of science
would hold no water for logical positivists.

There is good evidence that Hempel would be averse to allowing social,
political and ethical values to be encoded in theories. He has argued that conﬁrmation
of hypotheses by evidence has nothing to do with value claims. Using the case of the
conﬁrmation of the existence of a certain kind of radiation belt surrounding Earth, he
contends that conﬁrmation of this hypothesis is independent of the ethical, political,
and social values of particular scientists. Rather it is solely a factual matter.66

To shore up his argument for purging theories of contextual values, Hempel
would probably critique Longino’s analysis of the Erhardt study of the biological basis
of sex role differences. Hempel could claim that although it could be argued that
evidence could be marshaled in favor of either one of the two models of the brain, the
one that does a better job of explaining the phenomena of gender role differences
should be preferred, without reference to the sort of ethical, political, and social values
that Longino claims that the two models embody and foster. Thus, for purely
epistemic reasons he would probably prefer the model that takes into account that
humans are a more complex species in terms of their intellectual abilities and social
relations than rats. Hempel would claim he was appealing to the epistemic merits
(such as explanatory scope and fruitfulness) of the two competing background

assumptions-models to decide between them, rather than any social, political, or

 

“Hempel, SHV, 91.

29

ethical values. He would decry any attempt to argue that the decisions to espouse one
of two competing theories should be made on the basis of the contextual values coded
in those theories. Such an argument would be entirely consistent with his logical-
positivist stance.

In response to his argument, Longino would probably argue that it is based on
the unwarranted supposition that epistemic values can always serve as the sole
arbitrators of background assumptions. There are at least two kinds of cases that
challenge that supposition.

Case One: Suppose you have two competing background assumptions with the
same kind and degree of epistemic merits (i.e., explanatory success, predictive
success, etc).'(’7 In that case, their epistemic merits cannot be the grounds on which one
could decide which one should be privileged over the other. Under such
circumstances, assuming that one may have limited research resources (and thus, one
could not keep seeking further experimental basis to decide between the two
background assumptions), and assuming that one might not want to arbitrarily pick
one background assumption over the other, one may want to decide between them on
substantive grounds, such as the contextual values encoded in them. For instance, one
would probably want to pick the background assumption that serves the purpose that
motivated one to theorize (say, the desire to alleviate human suffering) better than the
background assumption that is incompatible with that goal. In doing so, one would
have, in effect, decided between theories on the basis of the values contained in them.
What this case demonstrates is that logical-positivists like Hempel would not be

justiﬁed in assuming that the decision to choose between competing background

 

67As I noted earlier, Longino uses the term “background assumptions” variously to mean interests, point
of view, or theory. 1 use it here to denote theories that serves as background assumptions that mediate
between the hypotheses and evidence claims of other theories.

30

assumptions could always be made solely on the basis of epistemic values; in some
cases, one may very well have to use ethical, political, or social values to decide
between competing background assumptions.“8
Case Two: Suppose you have two competing background assumptions such
that they have varying degrees of epistemic merit. Background Assumption A scores
slightly higher than Background Assumption B as far as simplicity is concerned but
scores slightly lower than the former as far as explanatory scope is concerned69 but
both A and B have the same degree of success as far as other epistemic merits are
concerned. So, although Background Assumptions A and B have varying degrees of
epistemic success, unless one has substantive reasons for ranking simplicity over
explanatory scope or vice versa, for all intents and purposes, one ﬁnds oneself in the
same sort of quandary as one faced in Case One. What this case demonstrates (as did
Case One) is that logical- positivist like Hempel would not be justiﬁed in assuming
that epistemic values can always serve as the ﬁnal arbitrators between theories; in
some cases, one may very well have to appeal to ethical, political, or social values that
are embedded in those theories or ﬂip a coin. In response, Hempel might argue that
using Background Assumption A and B, in turn, two distinct version of the theory
should be developed, and then, depending on the epistemic merits of the competing
versions of the theory, say T-A and T-B, the scientiﬁc community should decide
between the two competing background assumptions. But that proposal is problematic
because, ﬁrst, the two competing theories may have differing epistemic virtues, with
neither one a clear-cut winner, and thus, one would ﬁnd oneself in the situation the

quandary described in Case A. And second, given that research monies are limited, it

 

“This could be done provisionally until future research reveals that one set of background assumptions
has a clear epistemic advantage. I owe this point to Professor J. Nelson.
69Assuming there is a way of quantifying these epistemic virtues.

31

is not likely that institutions will be willing to devote equal amounts of resources,
including labor hours, to develop two competing theories. Therefore, for pragmatic
reasons, one might have to decide between competing background assumptions on
non-epistemic, normative grounds.

Having described the strengths and weaknesses of Longino's position, now I
turn to Nelson’s criticism of that epistemology. I do so because her work is not limited
in the way Longino's is and it provides fresh insight into logical positivism. Nelson
offers what has the potential to be a categorical refutation of the idea that there can be

theories that are free of any contextual values.

2.4 Setting— Up Lynn Hankinson Nelson ’s Critique of the Logical-Positivist
Conception of Objectivity

Nelson contends that the logical-positivist notion of objectivity must be
rejected because it is based on the unwarranted assumption that a line can be drawn
between science, metaphysics, and values.70 Her analysis is rooted in Quine's
epistemology. In the interest of contextualizing Nelson's critique of logical positivism,
below, I outline Quine's position (I also discuss Quine's work because I draw on it to

critique Nelson.) After that, l delineate and critique Nelson's work.

 

70Nelson, Who Knows: From Quine to a Feminist Epistemology (WK).

32

2.5 Quine on Ordinary Language Metaphysics, Science, and Values

Unlike the logical positivists, Quine holds that metaphysics and science are
part of the same fabric.7l That is so for two interdependent reasons. First, our ordinary
language is committed to a macro-physical object metaphysics that allows us to make
sense of our experiences, and second, our ordinary language macro-physical object
metaphysics makes possible scientiﬁc theorizing (though the latter, in turn, shapes the
former too). Elaborating on that relationship, Quine holds that scientiﬁc claims make
sense only insofar as they are read against the backdrop of the macro-physical object
metaphysics of ordinary language because "the positing of physical objects must be
seen not as an ex post facto systematization of data, but as a move prior to which no
appreciable data would be available to systematize."72 Although ordinary language
macro-physical object metaphysics serves as a precondition and backdrop for
scientiﬁc theorizing, both the macro-physical object metaphysics and science serve the
same master. Their task is to make sense of experience. As servants to experience,
both are subject to revision if they are inconsistent with experience. The following

passage clearly demonstrates Quine's empiricist convictions:

The totality of our so-called knowledge or beliefs, from the most casual
matters of geography and history to the profoundest laws of atomic physics or
even of pure mathematics and logic, is a man-made fabric which impinges on
experience only on the edges. Or, to change the ﬁgure, total science is like a

ﬁeld of force whose boundary conditions are experience. A conﬂict with

 

7|Quine, “The Two Dogmas of Empiricism” (TDE), 79.

72Quine, “Posits and Reality,” 158. Quine also claims that "[c]ommon sense bodies, ﬁnally, are
conceptually fundamental: it is by reference to them that the very notions of reality and evidence are
acquired, and that the concepts which have to do with physical particles or even with sense data tend to
be framed and phrased" (“Posits and Reality,” 159).

33

experience at the periphery occasions readjustments in the interior of the ﬁeld

(my italics).73

Developing his analysis of the similarity between non-scientiﬁc theorizing (read:
common sense theorizing") that embodies and is built on our ordinary language
macro- physical object metaphysics and scientiﬁc theorizing, Quine contends that,
epistemically speaking, the macro-physical objects posited by common sense
theorizing as well as Homer's mythic divine ﬁgures are on par with conceptual

scientiﬁc constructs posited by, say, the atomic theory:

As an empiricist, I continue to think of the conceptual scheme of science as a
tool, ultimately for predicting future experiences in the light of past experience.
Physical objects are conceptually imported into the situation as convenient
intermediaries- not by definition in terms of experience, but simply as
irreducible posits comparable, epistemologically, to the gods of Homer...
Positing does not stop with macroscopic physical objects. Objects at the
atomic level are posited to make laws of macroscopic objects, and ultimately

the laws of experience, simpler and more manageable. . .(my italics).75

The thrust of Quine’s argument is that the logical positivists were not justiﬁed in

assuming that there was a categorical distinction between common sense and scientiﬁc

 

73Quine, TDE, 7s.

74The term 'common sense' theories is meant to denote the ordinary language macro-physical object
metaphysics. Lynn Hankinson Nelson uses it in that sense.

75Quine, TDE, 79.

34

theorizing. Both are part of the same fabric, constructed by humans to make sense of
the world.

Although Quine rejected the distinction that the logical positivist sought to
draw between common sense posits and scientiﬁc theoretical posits, he believed that
there was a difference in kind between scientiﬁc claims and value claims. Observation
claims on which scientiﬁc theories rest could be veriﬁed by testing their
correspondence with actual state of affairs, while value claims could not be subject to
such a veriﬁcation process. The best one could do with them was to test if they were

coherent with one's other value claims:

The empirical foothold of scientiﬁc theory is in the predictable observable
event; that of moral code is in the observable moral act. But whereas we can
test a prediction against the independent course of observable nature, we can
judge the morality of an act only by our moral standards themselves. Science,
thanks to its links with observation, retains some title to a correspondence
theory of truth; but a coherence theory is evidently the lot of ethics. Scientiﬁc
theories on all sorts of useful and useless topics are sustained by empirical
controls, partial and devious though they may be. It is bitter irony that so vital
a matter as the difference between good and evil should have no comparable

claim to objectivity (my italics).76

Although it would seem that it is quite clear that Quine, like the logical positivists,

wanted to draw a line between value claims and scientiﬁc claims, some have argued

 

7'SQuine, "On the Nature of Moral Values," 63.

35

that that is not his position. Richard Rudner, for instance, claims that Quine's
arguments in "On Carnap's View on Ontology," and "The Two Dogmas of
Empiricism" suggests that the conceptual distinction Carnap wants to draw between
value judgments (which he deems to be questions external to science) and theoretical
questions (which he considers to be internal questions for science and which are
addressed using observation claims) is one that Quine would reject.77 Rudner,
however, does not attempt to substantiate that claim about Quine's supposed stance by
engaging with the aforementioned essays.

Owen Flanagan has tried to make the argument that Rudner should have but
does not make for his "reading" of Quine. Flanagan has argued that Quine's rejection
of the two dogmas of empiricism (i.e., the analytic-synthetic distinction and radical
epistemological reductionism) entails a commitment to holism. He believes that
commitment would lead Quine to reject any attempt to draw a distinction between
scientiﬁc claims and value claims.

But Flanagan is wrong. Although Quine is a holist, he is not committed to the
radical holism that Flanagan attributes to him. Quine supports a mitigated form of
holism that "allows, nay, insists, that observation sentences have their own, individual
empirical (stimulus) meanings."78 That much is clear from Quine's insistence that even
the most well-trenched common sense or scientiﬁc theory should be rejected if it is not
borne out by experience. A radical holist, presumably, would be interested in
preserving the coherence of the entire system of knowledge, even if it meant giving a
short shriﬁ to observation claims that were inconsistent with one's larger network of

theories (which were consistent and coherent with each other). Thus, it could be

 

"Rudner, 1953, 5.
78Roger F. Gibson, "Flanagan on Quinean Ethics," 537.

36

argued that Rudner's "reading" of Quine is not justiﬁed either. Lynn Hankinson
Nelson has not aligned herself with Rudner or Flanagan. Rather she reads Quine as
committed to the position that there is a difference in kind between observations
claims (on which scientiﬁc theories rests) and value claims. Nelson argues that he is

wrong.

2. 6 Nelson ’s Critique of the Logical-Positivist Conception of Objectivity

Nelson makes no bones about the fact that she ﬁnds Quine’s critique of
logical-positivism compelling. However, she contends that not only is there no
boundary between metaphysics79 and scientiﬁc theories, there isn’t one between
metaphysics, science, and values. Here she parts ways with Quine, who held that there
was a fundamental difference between observation claims (on which scientiﬁc theories
rest) and value claims; the former are subject to a correspondence theory of truth (i.e.,
whether or not the observation claims match up with the world), whilst the latter can
only be assessed by a coherence theory of truth (whether value claims are coherent
with one another). For an empiricist like Quine, claims that could only be subject to a
coherence test were sadly unreliable compared to claims that could be subject to
empirical veriﬁcation. Summing up Quine's position, Nelson writes, “For now it is
clear that one of the directions we must take involves re-appraising what Bill Wisdom
call Descartes’ covenant: his promise, as Quine characterizes and advocates it, that
science will ‘stand aloot’ from values. (Quine, Roots of Reference, p.49).”80 She

also notes, “... Quine and the other empiricists have been concerned to exclude values,

 

79Nelson and Quine appear to use the terms “common sense theorizing” and “metaphysical theorizing”
interchangeably. Both terms are used in contrast to the term “scientiﬁc theorizing.”
$0Nelson, WK, 248.

37

including political interests, from the content of scientiﬁc theories and from their
accounts of the way we go about constructing theories- at least good theories.”81
Nelson gives two arguments in support of her claim that science is value—laden.
Her ﬁrst argument relies on the idea that all kinds of human actions or creations that
have social or political consequences have ethical import. As scientiﬁc theories are
things that humans create and insofar as they have political and social signiﬁcance,
they cannot be considered value neutral. To instantiate her point, Nelson uses the
theories of sociobiologist David Barash and Daniel Janzen. They have argued that
given that the rape of female mallards by male ones is a ﬁtness maximizing strategy
used by male mallards to secure their reproductive rights and given that variety of

other species also exhibit that behavior, humans ought to rethink how they view rape

of human females by human males:82

Rape in humans is by no means as simple [as rape among mallard ducks],
inﬂuenced as it is by an extremely complex overlay of cultural attitudes.
Nevertheless, mallard rape and bluebird adultery may have a degree of
relevance to hmnan behavior. Perhaps human rapists, in their own criminally
misguided way, are doing the best they can to maximize their ﬁtness. If so, they
are not that different from sexually excluded bachelor mallards (italicized by

Nelson). 83

 

"Nelson, WK, 260.

82This is a patently bad argument because it assumes that what science deems natural is morally
justiﬁed. I owe this point to Professor J. Nelson.

3Barash, David. 1979. The Whisperings Within. New York: Harper & Row., p.55. (In Nelson's WK on
page 159).

38

Nelson argues that although such theories purport to be purely descriptive, they are
laden with metaphysical assumptions about the nature of men and women.84
Moreover, she argues, as such theories construe heterosexual rape as an evolutionary

ﬁtness maximizing strategy; they appear to provide a veneer of legitimacy to violence

by men against women.85 Thus, Nelson contends, such theories cannot be regarded as

devoid of any ethical import:

The most sophisticated geneticist or zoologist can, under the guise of scientiﬁc
insulation from political context and the apolitical nature of scientiﬁc
theorizing, engage in and propound the most unsophisticated social and
political theorizing- and, in so doing, legitimize violence against women.
(Sociobiologist David) Barash's irresponsibility will, I hope, appall readers.
But the more far-reaching issue with which we need to contend is that his
explanation of rape can be offered as scientiﬁc and "value-free" because we
grant scientists cognitive authority that we do not scrutinize and insist that
scientiﬁc theorizing is value-free. Thus Barash feels free to reject any
responsibility for the implications of his claims. He is, on his account, simply

telling us how things are.86

The second reason that Nelson gives for categorizing science as not being autonomous
of values is tied to her critique of the logical-positivist conception of the epistemic

agent. The logical positivists held that it was possible for epistemic agents to be

 

“Nelson, WK, 160.
8’Nelson, WK, 158 and chapter four. It is worth noting that those who might be inclined to excuse
violence against women by men on the grounds that it is natural are guilty of a fallacy. Just because

something is natural does not mean that it is good or legitimate.
“Nelson, WK, 158.

39

objective cognitive authorities (i.e., they believed humans qua knowers could detach
themselves from all social, ethical, and political commitments and assume a value
neutral stance). Nelson’s refutation of this conception of the epistemic agent has two
parts. First, she challenges the metaphysical conception of the person underlying this
notion of the knower. Second, she argues that communities, not individuals, qualify as
primary epistemic agents. Given that communities have values, interests, and beliefs
that motivate and shape their theorizing, as epistemic agents they cannot be considered
objective. Below, I outline her two-part argument.

Nelson claims that the logical-positivist conception of the epistemic agent as
an objective cognitive authority is rooted in the metaphysical conception of
personhood underlying the moral and political philosophical writings of Immanuel
Kant, John Locke and Thomas Hobbes. Nelson notes that Alison Jaggar has argued
that this modern notion of the self is one that assumes that persons are prior to their
society. According to this conception, persons may have beliefs, values, interests and

desires that are independent of and uninﬂuenced by those that permeate their society:

The assumption is that human individuals are ontologically prior to society;
in other words, human individuals are the basic constituents out of which
social groups are composed. Logically, if not empirically, human individuals
could exist outside of a social context; their essential characteristics, their
needs and interests, their capacities and desires, are given independently of
their social context and are not created or even ﬁlndamentally altered by that

context.87

 

8’ Jaggar, I983, 28-9.

40

Drawing on Quine’s work on the social nature of experience, language and
knowledge, Nelson argues that the notion of a self that is logically prior to her social
context is not a viable one because the public conceptual framework (embodied in
ordinary language) of any society shapes individuals’ epistemic possibilities. Nelson

6“

writes that social preconditions’ are necessary for anyone to know, and even ‘basic
sense experiences’ are coherent only because they are shaped by public language
and a conceptual scheme, a body of theories embodied in language.”88 Given that
community membership is a necessary precondition for language development,
acquisition and formulation of beliefs, values and interests, and given that even
sensory perceptions are socially mediated,89 “theories and questions are necessarily
the product of social activity, and the experiences of individuals are made possible
and shaped by these” (my italics).90 Nelson also points out that because theories are
socially constructed, it can be argued that what constitutes evidence is also socially

determined,91 thus further undermining the possibility of epistemic agents who

function in utter isolation from their social context:

[E]vidence is (determined by) a public standard. It is deeply dependent on
public theorizing and, more speciﬁcally, on ‘common sense’ theorizing.
Individuals do not determine what constitutes evidence for a claim, but by the

standards a community accepts concomitantly with constructing, adopting, and

 

88 Nelson, WK, 259.

‘9 Nelson, WK, 285.

9° Nelson, WK, 277.

9'This is a deeply problematic claim that seriously undermines Nelson's position although she is not
aware of that fact; I discuss it in the next section.

41

reﬁning theories. These constrain what it is possible for an individual to

believe as well as the theorizing we engage in together.92

Thus, individuals cannot be regarded as logically prior to their communities, and
therefore, they cannot be the sort of objective epistemic agents that the logical-
positivists want them to be. What also falls out of that critique is that communities, not
individuals, are primary epistemic agents.93 In other words, knowledge is made
possible by and created by communities of knowers.

Elaborating on the notion of communities as epistemic agents, Nelson claims
that by virtue of their shared knowledge, practices and standards, scientiﬁc

communities qualify as paradigmatic cases of epistemic communities:

[E]pistemological communities can be identiﬁed in terms of shared
knowledge, standards, and practices. Science communities serve as obvious
examples of epistemological communities, with bodies of theory, accepted
procedures, questions, and projects deﬁning such communities; and
membership being a function of education in and allegiance to community-

speciﬁc knowledge, standards, and practices...“

Though Nelson identiﬁes scientiﬁc communities as paradigmatic epistemological

communities, she believes they are not the only communities engaged in knowledge

 

92 Nelson, WK, 277.

93At ﬁrst glance, Nelson's claim that communities have epistemic agency appears to be problematic. But
if one recognizes that communities make decisions about what qualiﬁes as knowledge and what does
not and who can be and who can't be a bearer of knowledge (for instance, historically and even today,
women in various societies have been denied recognition as capable of having scientiﬁc knowledge),
the attribution of agency to communities seems appropriate.

9‘ Nelson, BC, 148.

42

production. Given that the theorizing that goes on within scientiﬁc communities is not
independent of the beliefs, values, and notions ﬂoating about within the larger non-
scientiﬁc communities, non-scientiﬁc communities must also be recognized as

epistemic communities:

But scientiﬁc communities are not the only epistemological communities, nor
have they a lock on generating knowledge. In terms of their very existence and
authority, and the knowledge and standards they generate, scientiﬁc
communities are interdependent with the larger communities within which they
function. More to the point, there are, in fact, many communities that develop
and share knowledge and standards, including our larger world community and

its multiple and evolving sub-communities.95

Nelson describes epistemic communities, speciﬁcally non-scientiﬁc epistemic
communities, as dynamic entities with porous, shifting boundaries.96 However, they
are not reducible to mere aggregates of individual knowers. Individuals cannot be said
to be knowers except as members of these communities because these communities
offer their members ways of organizing and grasping the world. And it is because
these communities offer us, their members, “standards and knowledge that enable us
to organize our experiences into coherent accounts, underwrite the speciﬁc
contributions that we make as individuals, and determine what we and our

communities will recognize as knowledge” that we have to concede that they are

 

9‘ Nelson, EC, 148.
9‘ Nelson, EC, 149.

43

epistemic communities and primary knowers.97 (They are primary knowers in the
sense that it is only as members of these communities that humans function as
knowers.)

Given that communities have values, beliefs, interests and given that scientiﬁc
and commonsense theories are the product of these communities that reﬂect their
concerns, the larger implication of Nelson’s argument is that scientiﬁc theorizing
cannot be regarded as aloof from values: “Science is not autonomous from common-
sense dealings with the world, or from social and political interests, and values. The
beliefs, practices, and experiences of scientists as members of our larger community

bOth permit and shape the theorizing done in these special communities?"8

2. 7 Strengths and Limitations of Nelson ’3 Analysis

Nelson’s analysis is compelling but it could be challenged on the grounds that
although in some scientiﬁc disciplines, say sociobiology, theorizing may be value
laden, that is not necessarily the case for other sciences such as physics.99 To respond
to that argument, I draw on what Nelson has to say to the charge that only certain
scientiﬁc disciplines are gender biased. I make this move because the issue of gender
bias in the sciences is essentially an issue of ethical, social, and political values

permeating scientiﬁc theorizing.

 

97 Nelson, BC, 150. This also means that for one to yodel, one must be part of a community of
yodellers. otherwise it is just a sound and not a yodel. Even though particular persons yodel, yodelling
is a socially constructed practice. I owe this point to Professor J. Nelson.

9“ Nelson, WK, 315.

99This is also a problem for Longino.

44

Nelson gives two arguments in response to the claim by Sandra Harding and
others that physics may be a science that is not corrupted by gender bias. '00 Nelson’s
weaker response to this claim is that although we may not yet be able to see the gender
bias that may be at work in physics, it would be unwise for us to conclude that it is
categorically free of sexism?"

Nelson’s stronger response to Harding is that even if physics is free of gender
bias that has no larger signiﬁcance for science as a whole. She also argues that given
Quine’s analysis of the interconnection and dependence between scientiﬁc and

common sense theorizing, neither physics nor any other highly abstract discipline can

be considered untainted by gender bias:

A fundamental part of Quine’s argument against the analytic/synthetic
distinction is that the meanings of mathematical and logical sentences, and the
point holds no less for those of theoretical physics, are related to and shaped

by the other sentences to which these bear a relationship- and ultimately, to and

 

I00Harding makes that claim while responding to those persons who attempt to minimize the
signiﬁcance of feminist analyses that show science to be a value-laden enterprise. Such persons argue
that those feminist critiques are only applicable to "'the less rigorous' or 'less mature' biological and
social sciences " and not science as a discipline (Harding, Sandra. 1986. The Science Question in
Feminism. (SQF). Cornell UP. 1986. 43 )." They contend that those critiques do not establish that
scientiﬁc inquiry cannot be value neutral. To do that feminists would have to show that the theories of
physics are value laden because it is the paradigm scientiﬁc discipline.

Harding's response to that charge is that physics ought not be considered the discipline that
embodies science because it is fundamentally different from the various other disciplines, such as the
biological and social sciences, that also fall under the rubric of science. Harding is interested in
dethroning physics as the paradigm science because she believes that would mean that the argument
that feminist analyses of science as a value-laden activity only apply to the less developed, less rigorous
scientiﬁc disciplines will fall apart. In other words, those who do not take feminist critiques of science
seriously would have to change their attitude.

In making that argument, Harding concedes that physics, albeit not the paradigm science, is
value neutral. She writes, "[W]e should understand physics not as the model for all scientiﬁc inquiry,
but as atypical of inquiry just insofar as its ontological and methodological assumptions can in fact
secure value free results of research" (Harding, SQF, 48).

It is that concession on Harding's part that physics is value neutral that Nelson picks up on and
criticizes.

'°‘ Nelson, WK, 250.

45

by all other things we say about the world... Given this view of empirical
content, no sentence or body of theory has the kind of purity or independence
from other theories that Harding (43-44, 1986) suggest we grant to physics.
There is no separating physics, or pure mathematics, or logic, or any other
theory from the rest of our going theories. The sentences of each are not ‘pure’
of empirical content or without connections- a sharing of supports and a

sharing of meaning —with other theories. '02

Although Nelson categorically rejects the possibility of value-free science, it is not
entirely clear what she means by the claim "science is not aloof from values." If she
means that the personal values of the individual scientiﬁc practitioner may inﬂuence
her/his choice of ﬁeld as well as her/his choice of problems and method of
investigation, not all logical-positivists would disagree with her. Hempel, for instance,
would have no trouble conceding to her point. ‘03 Or if she means that social, ethical,
and political values determine the direction of research as well as "encourage the
advocacy of ill-founded theories," Hempel, again, would be in agreement with her that

science is value laden in that sense as well.‘04

Alternatively, if she were to claim that
epistemic norms, such as theoretical simplicity, truth, predictive prowess, accuracy
and explanatory scope, are used by the scientiﬁc community to assess competing
theories, Hempel would be willing to concede to that point too.105 Given that Hempel

recognizes that science could be value laden in all of these ways, it could be assumed

that he might also be amenable to acknowledging Nelson's claim that scientiﬁc

 

'°2 Nelson, WK, 250-2.

'°’Hempel, vos, 372.

'“Hempel, vos, 372-3 and snv, 4o.
'°’Hempel, vos, 372-3.

46

theorizing cannot be considered value-neutral because it has political and social
consequences. Alternatively, one could suppose that when Nelson claims that science
is a value laden activity, she means that scientists make value judgments when they,
for instance, decide whether a particular level of risk associated with testing a certain
hypothesis is acceptable or not?” Richard Rudner has argued Carnap would reject the
claim that scientists as scientists make value judgments on the grounds that those sorts
of questions are external to science. Rudner writes, "Carnap can still deny the essential
involvement of the making of value judgments in the procedures of science by
insisting that concerns with external questions, admittedly necessary and admittedly
axiological, is nevertheless in some sense a pre-scientiﬁc concern."107 Whether
Hempel would echo his fellow logical positivists' rejection of Rudner's claim is not
obvious.

But even if Hempel were to concede that science is value laden in the sense
Rudner means, Nelson would probably argue that Rudner does not capture what she
means when she asserts that science is not aloof from values.108 Nelson might
elaborate on her position as follows: Given that science is the product of the larger
epistemic communities (and not just the scientiﬁc epistemic community) and that
communities have values, beliefs, interests, which motivate and shape their knowledge
building projects, scientiﬁc theorizing should not be considered as different from
common-sense theorizing in the sense that one is regarded as being objective (i.e.,

autonomous of values) whilst the other is not. Her argument effectively highlights the

 

'“Rudner, "The Scientist "Qua" Scientist Makes Value Judgments," 3.

loI'Rudner, 5.

'osThis is not to say that she wouldn't recognize that scientiﬁc practice was value laden in the sense
Rudner meant.

47

deep connection between scientiﬁc theorizing and the larger non-scientiﬁc epistemic
community that the logical positivists overlooked.

Though Nelson argues that scientiﬁc theorizing is not aloof from values, she
does not mean to suggest all theories, regardless of the contextual values they endorse,
are on par. She contends that our decision to commit to a certain theory, as opposed to
another, should be based on evidence for or against the value laden claims endorsed by

the theories in question:

Feminist scholarship, including science criticism, indicates that ‘culturally
determined beliefs’, including political views and views about sex/gender, can
be and should be subjected to empirical controls.l09 Feminist science critics
have been able to evaluate the assumptions about sex/gender and politics
involved in scientiﬁc theories and to do so on the basis of evidence. There is
evidence that women’s activities are central to the dynamics of human social
groups, and that androcentricism has distorted cross-cultural studies, animal
sociology, and evolutionary theory. There is evidence that indicates that male
dominance is neither natural nor universal, that research into sex differences is
wrongheaded, and that current divisions in power by sex/gender are not based
on, or justiﬁable on the basis of biology. Moreover, the evidence that calls the
various theories into question that incorporated these things has at its most
basic source common-sense experience and theorizing, including political

experience and theorizing. So, common-sense theory is itself not static or

 

I09By "empirical control," I take Nelson to mean veriﬁcation of evidence.

48

unable to be subjected to empirical control. It is currently changing in dramatic

ways within sub-communities in our larger community (my italics).l '0

The above passage indicates that Nelson holds that epistemic communities should
evaluate theories about gender on the basis of "empirical controls." Her use of that
phrase suggests that she is arguing that theories of gender should be subject to
veriﬁcation or testing. That veriﬁcation would occur by using evidence (i.e.,
observation claims about the world) that would conclusively demonstrate whether
theories arguing for men's natural superiority and dominance over women are justiﬁed
or not (see passage quoted above). I H In arguing that such theories should be tested
using evidence, speciﬁcally, observation claims about men's and women's behavior,
Nelson must believe that that the evidence in question is neutral with respect to the
competing theories at issue. Otherwise she would not suggest using it to judge
between competing theories (see passage quoted above).

Nelson’s claim that evidence (i.e., observation claims based on basic sense
experience (see passage quoted above)) can be used to decide conclusively between
the competing value laden theories is problematic. Her proposal is predicated on the
assumption that evidence (i.e., observation claims based on basic sense experience)
can serve as the neutral arbitrator between competing paradigms. But I believe she is

not justiﬁed in asserting that because she has also made the following three claims:

 

"°Nelson, WK, 248-9.
IllHere Nelson parts ways with Longino, Quine, and other empiricists (Nelson, WK, 248). She claims
that they hold that value claims cannot be evaluated.

49

i. Basic sense experiences are "coherent only because they are shaped by public

language and a conceptual scheme, a body of (common-sense ) theoriesl '2 embodied

in language (in general and not just particular languages)?l ‘3
ii. Public theorizing shapes and is shaped by scientiﬁc theories.1 '4
iii. Public theorizing determines what counts as evidence.1 '5

If Nelson holds that i, ii, and iii, then she cannot also make the claim that
"evidence" can be used as a neutral arbitrator to decide between competing value
laden scientiﬁc theories without contradicting herself. She can't have her cake and eat
it too.

Aside from the problem of self-refutation, there are other aspects of Nelson's
stance that merit scrutiny. Nelson claims that basic sense evidence is made coherent
by common sense theories, which shape and are shaped by scientiﬁc theories. She

6“

writes, social preconditions’ are necessary for anyone to know, and even ‘basic
sense experiences’ are coherent only because they are shaped by public language and a
conceptual scheme, a body of theories embodied in language.”l 16 Her use of
"coherent" in this context suggests she believes that it is only by virtue of membership
in a linguistic community that basic sense experiences are experienced or processed by

humans in a consistent way. I take that to mean that it is only because we are members

of epistemic communities that we consistently experience the same basic sense

 

”2 Nelson uses the term 'common sense' theories is meant to denote the ordinary language macro-
hysical object metaphysics.

I3Nelson, WK, 259. Nelson notes that Quine shares the empiricist commitment to objectivity,
understood as entailing the exclusion of political interests and values from scientiﬁc theories and the
construction of theories (Nelson, WK, 260). Nelson writes, “. .. Quine and the other empiricists have
been concerned to exclude values, including political interests, from the content of scientiﬁc theories
and from their accounts of the way we go about constructing theories- at least good theories” (Nelson,
WK, 260) Nelson also differentiates her position from Quine’s (Nelson, WK, 265).

"‘Nelson, WK, 277.
”’Nelson, WK, 277.
”‘Nelson, WK, 259.

50

stimulus, say a surface heated to a 100 degrees farenheit, in the same way each time
we come into contact with it. On Nelson's account, all other things being equal, one's
basic sense experiences of that heated surface would vary each time one came into
contact with it, rendering that experience incoherent and choatic, if one were not a
member of a linguistic community.

In taking that stance, Nelson commits herself to a form of social constructivism
that is even more radical than the one proposed by R. N. Hanson. He contends that
even though two people have the same sense experience of a phenomena, their
observation claims reﬂect their theoretical commitments. While in terms of basic
sense experience (speciﬁcally, color and size), both Johannes Kepler and Tycho Brahe
saw the same phenomena- the sun and various other celestial bodies- their observation
claims about the phenomena were theory laden. The former's claim reﬂected his
commitment to a heliocentric conception of the universe, while the latter's observation
statement echoed his commitment to a geocentric account of the universe.1 '7

Like Hanson, Nelson is a social contructivist. However, she subscribes to a
radical verison of the position. For her, even basic sense experience is theoretically
mediated. On Nelson's account, Kepler and Brahe would not even see the same thing.
It is unlikely that that form of social constructivism is a viable position. The behavior
of newborns, for instance, indicates that basic sensory experiences are coherent to
them even though they lack any sort of linguistic abilities.118 That newborns
consistently react to sensations they experience as uncomfortable, say an overheated

environment, by crying indicates that those basic sense experiences are coherent to

 

l”'Hanson, Patterns of Discovery, 7.

”8For instance, Jacob E. Steiner, Dieter Glaser, Maria E. Hawilo and Kent C. Berridge's research shows
that that human newborns and newborns of other primates consistently react to sweet and bitter taste
stimuli ("Comparative expression of hedonic impact: affective reactions to taste by human infants and
other primates" in Neuroscience & Biobehavioral Reviews. Vol. 25, no. I. 2001, 53-74.)

51

them (i.e., they consistently experience them in the same way) even though they are
not members of any linguistic community, and thus, are not privy to any theoretical
framework.

There is some evidence that Nelson might see the merit of my critique of her
work. Her discussion of fetal and postnatal neurobiology suggests that much: “Our
current understandings of neurobiological development, for example, indicate that
interpersonal experience is a necessary causal factor in the fetal and postnatal
neurobiological development that permits language acquisition, conceptualization and
many perceptual experiences (my italics)”l '9 I believe that her use of "many"
indicates that she does not believe all perceptual experience is culturally mediated. But
it is a problem that that claim is at odds with her categorical assertion that basic sense
experience is made coherent by membership in epistemic communities.

In response to my argument against her radical social constructivist position,
Nelson might argue that my theoretical commitment (to the idea that basic sense
experience is not theoretically mediated) has colored my reading of newborns'
behavior. I believe that response highlights yet another problem with the form of
social constructivism that Nelson appears to be espousing. Proponents of radical social
constructivism can discount all attempts to refute their position by reading them as
mere reﬂection of the theoretical commitments of their opponents, and thus, not
consider them a challenge to their position. I have serious reservations whether a

theory, in this case, radical social constructivism, that does not admit of conditions

 

”Nelson, WK, 285.

52

under which it could be refuted or falsiﬁed, and thus, does much to encourage critical
dialogue. That kind of dialogue is crucial to science if it is not to be dogmatic.‘20

In her own defense, Nelson could try to argue that by positing evidence as
empirical control for theories, she is only following in the footsteps of Quine. But
Nelson can't evoke that line of defense because by "empirical controls" Quine means
sense experience, i.e., the impinging of the world on human sensory organs, which he
considers to be independent of and unmediated by one's theoretical commitments'21
Thus, a fundamental difference between Nelson and Quine is that while the latter is
committed to realism with respect to basic sense experiences, the former is a social
constructivist all the way through. Given these problems with Nelson's account of the
presence of values in science, her position should not be accepted uncritically.

Having assessed both Nelson's and Longino's critique of the logical-positivist
conception of objectivity, now, I articulate a notion of objectivity that is based on my
analysis of their work. I believe that philosophers of medicine and medical theorists
ought to adopt it because it is informed by actual human epistemic practices (unlike
the logical positivist one) and it is more capable of identifying the values shaping
theories than the one that logical positivists subscribed to (I argue the latter point in

chapters three and four).

2.8 An Alternative Notion of Objectivity
I contend objectivity is a stance or a particular way of engaging with the

world. Its adoption by epsitemic agents means, amongst other things, recognizing that

 

'ZOOne of the reasons creationism, for instance, cannot lay claim to being a scientiﬁc theory is that it
does not admit of conditions under which it could be falsiﬁed.
'Z'Quine, TDE, 80. See earlier discussion of Quine's position.

53

all theories are value-laden. Theories are created by scientiﬁc communities as well as
the larger non-scientiﬁc community within which the scientiﬁc communities are
embedded. The theories formulated by these epistemic communities reﬂect and are
expressive of their values and interests.122

Although this argument may appear to be the same as Nelson's, it is not. The
following three claims capture the fundamentals of my position, whilst highlighting
the similarities and differences between it and Nelson's stance:
i. Unlike Nelson, I believe basic sense experience is independent of common
sense and scientiﬁc theorizing. This is a crucial point because it allows me to argue
that basic sense experience can be used to serve as neutral arbitrator between
competing theories, whilst sidestepping the problem of self-refutation that Nelson runs
into.
ii. I, like Nelson, hold that there is a deep connection and interdepedence between
common sense theorizing and scientiﬁc theorizing because communities, rather than
individuals, are primary knowers of theories. It is by virtue of one's membership in
epsitemic communities that one knows the world. (This claim is consistent with (i)
because that is an assertion about basic sense experience, while this claim is about
non-scientiﬁc and scientiﬁc theories.)
iii. Along with Nelson, I believe that given the deep connection between common
sense and scientiﬁc theories, no scientiﬁc theory can be considered value free. All
theories reﬂect the values, interests, and beliefs of the larger non-scientiﬁc epistemic

community within which the scientiﬁc community that produced that theory is lodged.

 

'zzThat is not to say that theories that are expressive of oppressive values should not be discarded in
favor of others that are not encoded with such values.

54

Thus, it must be acknowledged that cultural norms necessarily play a role in shaping
scientiﬁc theories.

Although I hold that particular scientiﬁc and medical theories are the product
of speciﬁc forms of life (i.e., cultures), I acknowledge that virtually no culture is
homogeneous, with only one coherent set of beliefs, values, and interests. Therefore,
scientiﬁc and medical theories must be understood as representing the complex
interplay between the various values, interests, and beliefs of a particular society. I
also want to qualify my position by arguing that although a particular society may
have produced a certain theory, it does not mean that no other culture could have
constructed it. For instance, it could be argued that it is unlikely that the current
Hmong culture could have produced the atomic theory but (given that cultures change
over time), it could at some point in the future become the kind of society that might
have created that theory. Cultures are not static but change as the material
circumstances of life change. Also, given that very few cultures are categorically
isolated from others, I contend the interplay between various forms of life also
accounts for changes in them.

Even as I argue that scientiﬁc theories reﬂect the values, interests, and beliefs
of the societies that generated them, I do not mean to deny that the use a particular
society makes of a certain theory may imbue it with a different sort of ethical or
political signiﬁcance than the one that it "had" by virtue of being the product of a
society that was committed to a certain form of life. For instance, a scientiﬁc theory
developed by a society, speciﬁcally, for the purposes of developing warfare
technologies, if used by another society for therapeutic purposes would in that cultural

context have a different value than what it had in the society that originally conceived

55

of it. It would also mean that those two societies would conceptualize and interact
differently with the world.

The notion of objectivity that I endorse places a premium on encouraging
critical dialogue as means for testing the merits of the theoretical model under
consideration. Thus, as part of that conception of objectivity I advocate the use of the
six strategies that Longino proposes for encouraging such dialogue. They are as
follows:

I. There are and should be publicly recognized forums (such as meetings,
conferences, journals, etc.) for critiquing hypotheses, evidence, methodology, and

inference

2. The social and epsitemic standards by reference to which theories, hypotheses

and evidence claims are critiqued should be and are public.

3. The scientiﬁc community should and usually does tolerate dissent and

responds appropriately to criticism.

4. Scientists should know the history of their discipline (as that would give them

critical insight into it).

5. The various communities engaged in critical dialogue should and, arguably, do
afford each other equal respect on the basis of their arguments rather than because of a

certain group’s social or political power.‘23

6. The scientiﬁc community should engage in dialogue with disenfranchised
communities in the interest of identifying culturally pervasive assumptions and values

ingrained in theories that might be invisible to the members of the scientiﬁc

 

mLongino, SPK, 273 and SSK, 76-81.

56

community by virtue of their dominant position but visible to those at the margins of

society.

Besides the above mentioned six strategies, I also advocate that the
institutional and cultural context of medical theories should be analyzed through the
eyes of the historically oppressed populations.124 That strategy is different from the
one that Longino has proposed. She claims that scientists be aware of the history of
the ﬁeld they are working in in the interest of having a critical perspective on it. While
that approach can be fruitﬁil (and thus, I endorse it too), I believe my approach has the
potential to generate a different kind of critique than the one that scientists versed in
the history of their ﬁeld but who unquestioningly accept the dominant oppressive
value system might be likely to produce.125 In the next chapter, I demonstrate the
efﬁcacy of that strategy by applying it two theories that medicalize menstruation as a

pathological condition.

I have argued that objectivity is a way of engaging with the world that requires
that epistemic agents acknowledge, amongst other things, that cultural norms
necessarily play a role in shaping theories. However, I do not believe commitment to
that notion of objectivity precludes the possibility of theorists recognizing that
particular theories may also have values embedded in them in a number of other ways.
For instance, values may be present in particular theories in the following ﬁve

ways: ‘26

 

'z’ln chapter ﬁve, I discuss at some length the question why epistemic privileged should be afforded to
the marginalized.

'ZSAlthough Longino does not espouse my strategy, I believe that she would ﬁnd it appealing because it
is consistent with her overarching goal of science as a practice that is self conscious and critical.

l2"This is not to say that these are the only ways in which values may be present in particular theories.

57

1. Scientiﬁc theories may contain value laden background assumptions'27 that
mediate the relationship between hypotheses and evidence cannot be considered value
neutral. (That, as Longino acknowledges, does not mean that all theories have values
in this respect but only those who have these sorts of background assumptions.)
2. It must also be conceded that insofar as particular theories contain concepts
that are value laden, those theories may not lay claim to being value free.
3. The shape of scientiﬁc theories (for example, which hypothesis is developed
and which one is not) could also be determined by contextual values that are not
embedded in the theories proper (in chapter three, I use some case studies to
demonstrate this point).
4. A scientiﬁc theory cannot lay claim to being value neutral if its development or
testing required that scientists make decisions about the acceptable level of risks posed
by particular research projects or products. 128
5. Given that technologies are the means by which humans organize or interact
with their material and social world, scientiﬁc theories qualify as technologies. Insofar
as technologies have a social impact, they cannot be considered devoid of any political
or ethical signiﬁcance. Thus, to the degree any scientiﬁc theory qua technology is used
by humans to organize or interact with the world in a manner that has a social impact,
it cannot be said to be ethically or political neutral.

My notion of objectivity is informed by human epistemic practices. Given the
social, value laden nature of knowledge building activities, all theories have contextual
values. All theories are value laden in the sense that they are expressions of the values

and concerns of the communities that formulated them (and they may have value laden

 

'27See earlier footnote on Longino's use of the term "background assumption."

'ZSSee earlier discussion about Rudner's argument about scientists qua scientists making value
decisions.

58

concepts and background assumptions). Thus, I contend it is problematic to speak of
"objective" as a predicate applicable to theories or to science as a discipline. My
position is at odds with Hempel's. He claimed that knowledge (read: claims about the
world, including theories) could be objective129 (see section 2.1 of this chapter for
account of Hempel's notion of objectivity).

As Nelson has argued that all theories have contextual values, she, I believe,
might be receptive to my position that "objective" is not a predicate applicable to
theories (Nelson does not articulate a notion of objectivity nor does she offer any
straegies for identifying the values shaping theories). Given that Longino has argued
objectivity is a method of inquiry that entails critical dialogue about scientiﬁc
theories,130 I believe she too might be receptive to my notion of objectivity even
though there are signiﬁcant differences between our positions.

In the next chapter, I elaborate on and argue for my notion of objectivity,
focusing on the strategy of assessing medical theories as well as their institutional and
cultural context through the eyes of historically oppressed populations. I make the case
that approach could render visible values shaping theories that might otherwise remain

invisible.

 

'29Hempel, 1965, I4]. Emphasis in original. As noted in section 2.1, Hempel argues that even Carnap
can be read as being committed to this conception of objectivity (Hempel, VOS, 380-1).

130See above account of the critical practices endorsed by Longino as part of her notion of objectivity.
Also, see SSK, 76.

59

CHAPTER THREE

3. 0 Introduction

In this chapter, I use my notion of objectivity to analyze two recent theories
medicalizing monthly menstruation.” ' I view these theories through the eyes of
marginalized communities. I argue that the contextual values embedded in the theories
as well as their cultural and institutional values play a signiﬁcant role in shaping the
two theories. I begin by describing and analyzing R.V. Short and Williams Obstetrics’
menstruation-as-pathology theory. Then, I detail and analyze Elsimar Coutinho and

Sheldon Segal’s menstruation-as-pathology theory.

3.1 Williams Obstetrics' Menstruation-as-PathologicaI-Evolutionary-A berration

Theory

In North America, Williams Obstetrics has the status of an epistemic authority
on women's reproductive physiology. Since the 19805, in every edition of this
obstetrics textbook, monthly menstruation has been portrayed as a diseased
evolutionary abnormality. In the 1993 edition, for instance, the editors, Gary
Cunningham, Paul MacDonald, Norman Grant, Kenneth Leveno and Larry Gilstrap
claim that because monthly menstruation is not the evolutionary norm for non-human
female primates and because some women (percentage unknown) experience the

sociall debilitatin PMS,I32 women’s riodicit is an evolutiona aberration that is
Y 8 P3 y FY

 

'3 'A version of this chapter was published as “Of Sex, Nationalities and Populations: The Construction
of Menstruation as a Patho-Physiology,” Menstruation: A Cultural History. Andrew Shail and Gillian
Howe eds.(Basingstoke: Palgrave- MacMillan 2005.

mWilliams Obstetrics, 1993, 97.

60

pathological.I33 They characterize it as an endocrinopathy (i.e., an inherent hormonal

disorder):

With all good intentions, we have reassured our daughters that cyclical
menstruation is normal; and from this perspective, it has been assumed by
many women that repetitive menstruation is equated with femininity. If this
prevalent premise that recurrent ovulation is the biological evolutionary norm
were incorrect, it would be easier to accept the likelihood that the recurrent
secretion and withdrawal of progesterone is an endocrinopathy that is pivotal

in the development of luteal phase disabilities (i.e., PMS).I34

The implication of this argument is that menstrual suppressant contraceptives ought to
be used as ‘treatment’ for all females of childbearing age, barring those contemplating

pregnancy.I35

3.2 Short ’3 Menstruation-as-Pathological-Evolutionary-A berration Theory

The editors of Williams Obstetrics owe this theory to R.V. Short, a British
veterinarian. Short’s 1976 "Evolution of Human Reproduction" argued that in
evolutionary terms monthly menstruation was a recent phenomenon attributable to the
agricultural revolution. The increased availability of food heralded an increase in

human female fertility, followed by the development of various means of

 

”’These ideas, in one form or another, are voiced in the 1989, 1997 and 2001 editions of this textbook
as well.

l3"Williams Obstetrics, 1993, 98.

l”The "logic" of their argument is discussed later.

6]

contraception. That development, in conjunction with better diet, resulted in human
females experiencing a nine-fold increase in monthly menstrual cycles (previously
their menstrual cycles were not monthly). Short contended that the increase in the
number of monthly menstrual cycles was an evolutionary aberration because females
of other primate species did not experience it and neither did women in primitive

human societies, such as the !Kung hunter-gatherers of the Kalahari Desert:

There can be no doubt that this ninefold increase in the time spent having
menstrual cycles poses a number of new problems for us; it is something of
which we have had no prior evolutionary experience, and hence we are not
genetically adapted to cope with this situation... If an endless succession of
menstrual cycles is a relatively new experience for us, we must immediately

ask whether they are in any way harmful.I36

He charged that this deviance from the evolutionary norm for primates must be
considered pathological because monthly menstruation in human females is correlated
with the incidence of certain forms of cancer,‘37 premenstrual syndrome (PMS) that
impairs women's ability to function well socially, and blood loss, which seriously
compromises malnourished women in developing nations. '38 On the basis of this

analysis, Short concluded:

 

”631m 1976, 18-9.
mThejury is still out on this one.
I38Short 1976. I discuss the issue of anemia later in this chapter.

62

Since the female is the limiting reproductive resource,139 it seems sensible that
we should emulate nature and concentrate mainly on female-oriented birth
control technology. We should also try to recapture what civilization has
destroyed, the ability to keep the ovaries and the female reproductive tract in a
state of quiescence when reproduction is not desired. Women may be
psychologically ill-adapted to spend the greater part of their reproductive lives

having an endless succession of menstrual cycles.140

He believed that his work “highlighted the importance of developing a non-steroidal
contraceptive that would allow a woman to return to the reproductive state that was
the norm for our primitive ancestors- amenorrhea.””'

Of the various reasons that Short gave for his position, his PMS argument‘42 is
the least speculative. Short’s claims about PMS were derived from the work of a
British psychologist and general practitioner Katharina Dalton. As Dalton's research is
central to Short's argument, I brieﬂy discuss her work.

Dalton, researching in 1960, noted that out of a group of 2 l 7 11-17 year old
girls, the performance level of 54 girls fell by a letter grade in academics and
housekeeping tasks during their pre-menstrual phase, and rose to its former level in the
week following menstruation. Dalton attributed the change in academic performance

to water retention during the pre-menstruum. She concluded that, "[a]bout one girl in

every six in any examination entry will be in her pre-menstruum and thus at her lowest

 

I39Short argued since females invested greater energy than males during reproduction (females gestate,

males don't), and "human societies tend to be polygynous, woman is the limiting resource (in
reproduction)" (Short, 1976, 5).

‘ Short 1976,21.

”'Short, 1976,20.

"2Short, 1976, 19.

63

intellectual ebb. While zealots campaign assiduously for equality of the sexes Nature
refuses to grant equality even in one sex. " '43
Dalton’s 1961 "Menstruation and Crime" argued that there was a signiﬁcant
correlation between the pre-menstruum and criminal behavior. Her claim was based
on a six-month long study of a group of 156 regularly menstruating women prisoners.
Dalton claimed that out of the group of 94 prisoners reported for bad behavior and
who menstruated regularly, misbehavior in 54% coincided with the pre-menstruum or
menstruation.144 Citing her earlier work, she noted that there was a marked similarity
between "the effect of menstruation on naughty schoolgirls, newly convicted women,
and disorderly prisoners."145 She claimed that though the offenses of the schoolgirls
and criminal women were different, they shared certain traits. She speculated that
menstrual hormonal changes probably made these females "less amenable to

n I46

discipline and thus inclined to misbehavior or criminal activity. But she also

acknowledged the possibility that the symptoms of PMS, including “lethargy, slower
reaction time and mental dullness,” may have made these females’ anti-social
activities more easily detectable than otherwise, accounting for more reports of
miscreant behavior. ”7
The problems with Dalton’s research are numerous, ranging from a lack of
control groups to the use of non-representative samples to unjustiﬁed conclusions to

I48

unwarranted universalizations. Therefore, Short was not justiﬁed in invoking her

 

”3Dalton, 1960a, 328.

'“"Misbehavior" is not evidence of "criminal behavior" but Dalton appears to think so.

”’Dalton, 1961, 1753.

'“Dalton, 1961, 1753.

"'Dalton, 1961, 1753.

I48Given that Dalton is herself a woman, her rejection of feminism is interesting. I address the issue of
women who subscribe to a patriarchal world view in chapter ﬁve. Also, see Emily Martin, 7, for a
developed critique of Dalton’s research.

64

research to derive his larger conclusion that monthly menstruation was a diseased
evolutionary aberration, necessitating use of menstrual suppressant contraceptives by
fertile women not considering pregnancy. Furthermore, insofar as the editors of
Williams Obstetrics rely on Short’s work (and albeit indirectly, Dalton’s research) to
categorize menstruation as an endocrinopathy, their analysis lacks credibility too.
Aside from these general methodological concerns, Short's attempt to argue
that women's reproductive physiology ought to conform to the evolutionary norm for
non-human primates is problematic because he makes no such demand of men’s
reproductive physiology. His treatment of the issue of the incidence of morphological
abnormal spermatozoa in human male semen is illustrative of this double standard. He
notes that in contrast to the semen of males of other primate species (with the
exception of gorillas), the sperm of human males has a greater incidence of
abnormality. Whilst Short acknowledges it as being responsible for the high incidence
of embryonic mortality in humans, he makes no effort to argue that that aspect of
human male reproductive physiology must be considered an evolutionary aberration

that is pathological:

Normal human semen is notorious for showing an extremely high proportion
of morphologically abnormal spermatozoa, often in excess of 40%, whereas
the other primates (except the gorilla) have remarkably uniform spermatozoa
(Seuanez, Martin & Short, unpublished observations). This suggests that a high
proportion of human spermatozoa may be genetically defective, and would

produce an abnormal embryo if they were capable of fertilizing the egg. There

65

is circumstantial evidence to suggest that we do suffer an extremely high

incidence of embryonic mortality.I49

It is also interesting to consider whether his work would have been enshrined in a
textbook on human physiology or anatomy if he had constructed a theory construing a
feature of human physiology that was common to men and women as a diseased
evolutionary aberration. For instance, if he had theorized that bi-pedalism is an
evolutionary aberration that is pathological because, ﬁrst, it is not common in other
primates, and second, it causes some percentage of the population to experience
various physical ailments, such as fallen arches and back pain, impairing their ability
to function well in society, it is unlikely his theory would have been enshrined in any
textbook on human physiology. But the analogous argument about women's
reproductive physiology has received uptake in Williams Obstetrics.

In general, although Short and the editors of Williams Obstetrics use
arguments mired in sexist bias and shoddy research to categorize women as
intrinsically ﬂawed entities,‘50 they consistently identify themselves as genuinely
concerned about women's well-being. For instance, Short worries about women
enduring "heavy, painful, and socially inconvenient" menstruation.” ' He also

expresses concern about the health of women in developing country being

 

M9Short 1976, I2. On Short's behalf, it could be argued that even though men's sperm may have a high
incidence of abnormality, it ought not be considered pathological because it does not impair men. In
contrast, menstruation should be considered pathological because it harms women. I owe this point to
Professor I . Nelson.

150" is also worth noting that by arguing for the use of menstrual suppressant contraceptives as
'treatment’ for monthly menstruation, Short and the editors of Williams Obstetrics are able to align
themselves with those who support reproductive rights. Thus, they could construe any critique of their
position as motivated by anti-choice and anti-birth control sentiments that compromise women’s well
being.

'S'Short, 1976,18.

66

compromised by menstruation if they have malaria or hookworm disease. 152 The
editors of Williams Obstetrics express similar sentiments. They claim that in this era

of scientiﬁc development

we as obstetricians look forward to the time when women can choose
infertility without obliging the endocrinopathy of recurrent progesterone
secretion in massive amounts, which also necessitates the associated distress of
menstruation that this choice now brings. We submit that each woman should
be able to select when to be (or not to be) pregnant as a positive demonstration
of her own choice without being obliged to make such a choice from a variety
of inadequate options. '53
Short et al.'s endorsement of the use of menstrual suppressant contraceptives (a form
of hormonal therapy) as the medical technological intervention of choice for women
with PMS and anemia is puzzling. During the 19603 and the 705 in Britain, when
Short formulated his theory, the standard treatment protocol for anemia was iron
tablets, and that for PMS was tranquilizers, diuretics, or hormonal therapies.154
Similarly, currently, in North America, anemia is usually treated using iron tablets,
while PMS is treated using psycho-phannaceuticals (such as anti-depressants and anti-
anxiety drugs), diuretics, or hormonal therapies.‘55 However, Short and the editors of

Williams Obstetrics contend the use of menstrual suppressant contraceptives is the

 

'SZShort, 1976, 18-9. He also articulates other worries in similar vein that appear to show his concern for
women's well being.

I”Williams Obstetrics, 1993, 15—6.

l5"Appleby 1964, "Premenstrual Symptoms" I973, Tonks 1975.

"’Dickerson, LM. "Premenstrual Syndrom," American Family Physician 15 April 2003; 67(8): 1743-
52.

67

solution to the health risk to women posed by monthly menstruation, without
providing arguments that demonstrate that all the standard treatments for PMS and
anemia have little or no efﬁcacy or, at any rate, are inferior to menstrual suppressant
contraceptives. What is also puzzling is that neither Short nor the editors of Williams
Obstetrics provide any explanation for their decision to advocate the wholesale use of
menstrual suppressant contraceptives for all women (barring those contemplating
pregnancy) rather than their selective use by women who suffer from PMS and
anemia.‘56
As Short's and the editors of Williams Obstetrics' menstruation-as-pathology
theories do not provide a satisfactory answer to those questions, I examine the cultural
context of their theories from the perspective of the socially marginalized in the hope
that it might provide some insight about their stance. I do not advocate examining the
social framework of theories solely from the perspective of the marginalized group
that the theory is about (in the case of the menstruation theory, that group is women). I
believe that because various forms of Oppression may be interconnected, scrutinizing
the cultural context of theories from multiple marginalized positions may reveal
things about the values shaping those theories that might not be visible if the inquiry is
limited in terms of the marginalized perspectives it draws on. So, in analyzing the
social framework of Short's theory, I evoke the perspective of those who are
marginalized- nationally and globally- in terms of their sex, race, class, and
nationality, rather than just their sex (I offer a fuller account of this strategy in chapter
ﬁve; I bracket this issue for now in the interest of maintaining the ﬂow of my analysis

of the menstruation theory).

 

I“Whether menstrual suppressant contraceptives are the appropriate treatment for anemia is discussed
later.

68

3.3 Scrutinizing the Cultural Context of Short Et Al. ’s T heorizing Using
Marginalized Perspectives

Short’s endorsement of menstrual suppressant contraceptives, rather than iron
tablets and mood stabilizers, as ‘treatment’ for problems like anemia and PMS
correlated with monthly menstruation takes on an interesting hue when it is considered
in light of his cultural context. Four years prior to the menstruation paper, in 1972,
Short, deeply inﬂuenced by Robert Malthus’ hypothesis about the relationship
between population grth and food supply work, had written “Reproduction and
Human Society.” He had argued that the rapid growth of population in Asia and Africa
posed a most serious threat to the survival of the human species. Short maintained that
the current accumulation of wealth by Western nations at the cost of nations in Asia
and Africa, coupled with the rapid growth of population in Asia and Africa,”7 had set

the stage for global conﬂict with potentially disastrous results:

Many economists have predicted that the rich nations of the world are destined
to grow richer, at the expense of the poor nations who are doomed to become
poorer. It seems doubtful if mankind could survive the ensuing racial and
national tensions if there was to be an increasing polarization between the

haves and the have-nots.158

Short appeared to believe that this global crisis could be averted if the West developed

population control strategies, speciﬁcally contraceptives, for the female populations of

 

I”In these poorer nations, children were "looked upon by parents as the best insurance against old age,

and by politicians as a way of ensuring that their country's voice would be heard in the council of
world" (Short, 1972, 124).
'“Short, 1972, 124.

69

Asia and Africa. In 1972, Short was not alone in expressing this populationist anxiety,
colored by racism, about the growth rate of population in Asia and Africa; in fact, he
was vocalizing sentiments that had been echoing across Britain for more than a decade
then. (I use the term ‘populationist’ to refer to the school of thought that holds that
high population growth is the most critical threat to economic development and
democracy).

Beginning in the 19505, an acute labor shortage in Britain had occasioned an
in—ﬂow of semi-skilled workers from former British colonies in South Asia and Africa
that had gained independence in the wake of WWII. Most of these immigrant labor
populations were concentrated in the industrial areas experiencing labor shortage.
David Eversley and Kollmann Wolfgang argue that the high fertility amongst these

9 in contrast to the low and

localized commonwealth immigrant populations,15
declining fertility amongst earlier white immigrant groups, coupled with stark
differences in social practices (such as dress, religious practices, festivals, shop hours)

and the resolution of the labor shortage, accounted for the public outcry amongst the

white working class citizens opposing the presence of colored new immigrants:

Where jobs and housing were already in short supply, the employed 'colored'
population was accused of taking jobs which 'should have been given' to the
indigenous populations, and keen resentment was felt, for example, against
immigrants with large families who thereby earned more points on council

house waiting lists and were accused of ‘jumping the queue.’ '60

 

'59Eversley and Wolfgang, 1982, 48.
l""Eversley and Wolfgang, 1982, 55-6.

70

Although, the ‘jumping the queue’ claims were not justiﬁed and the newer immigrants
were more economically vulnerable in periods of high employment than the white
citizenry)“ in response to these nationalist tirades, the British government
implemented the ﬁrst in a series of four immigration acts aimed at closing-off Britain
to South Asian and Aﬁ'ican immigrants. With the passage of the 1962 Commonwealth
Immigration Act, the British government began collecting data on the ﬂow of people
from its former colonies into Britain and limiting entry to those commonwealth
citizens who held work vouchers, their dependents and the dependents of those already
settled in the UK.'62 Until the passage of the 1962 Act, citizens of the British
commonwealth nations had not been regarded as aliens, and therefore, they had not
been subject to immigration control by the British government. In 1968, pandering to
continued public opposition to colored immigrants, the Commonwealth Immigration
Act was extended to include East-African Asians (the erstwhile business strata of
these nations had recently begun immigrating to Britain in increasing numbers). To
further placate the white working class populations, two other immigration control
acts were passed in 1969 and 1971 by the British government.

Short’s 1972 paper on the global population crisis cannot, therefore, be read as
having no local signiﬁcance. In fact, his 1976 “Evolution of Human Reproduction”
prescribing more or less universal use of menstrual suppressant contraceptives could
be read as an attempt to solve the ‘problem’ of high rates of reproduction amongst

colored populations within Britain and globally. I 63 When viewed against a larger

 

'“Eversley and Wolfgang, 1982, 56.

'62Eversley and Wolfgang, 1982, 439.

"’3 However, it must be acknowledged that he was also advocating menstrual suppressant contraceptive
use by white women as well. In response, it can be argued that his motivating factors are a complex
mix. I have already pointed out that he appeared to be genuinely committed to women's well-being even
while espousing sexist arguments.

71

cultural backdrop of racist, populationist paranoia, the espousal of menstrual
suppressant contraceptives certainly appears to be politically motivated.‘64

The analysis of the cultural context of Short's work from the perspective of
those at the margins of society reveals that his theory was shaped by sexism as well as
a host of other concerns. Speciﬁcally, his endorsement of menstrual suppressant
contraceptives as "treatment" for menstruation was motivated by a complex of
nationalist, racist, populationist concerns. I have also argued that those values were a
reﬂection of the concerns of the dominant population in Britain in that era. Thus,
Short's theory must not be understood as merely reﬂecting the idiosyncratic beliefs of
its creator but mirroring the concerns of the communities with whom he identiﬁed.

1 have analyzed the cultural context of Short's theory through the eyes of the
disenfranchised. That approach casts a different kind of light on Short's work
(speciﬁcally, his reliance on shoddy research, fallacious arguments, and espousal of
menstrual suppressant contraceptives as the treatment of choice for PMS and anemia)
than the light provided by the standard method for assessing theories (based on the
logical-positivist notion of objectivity). The standard approach for assessing theories
might be critical of his fallacious arguments and reliance on shoddy research but it
would assume that his theory was value-free because the evidence in support of the
hypotheses constituting his theory could be intersubjectively veriﬁed. Thus, the
standard method for evaluating theories would do little or nothing to make Short or
other medical theorists aware of the host of values shaping particular medical theories.

In contrast, my approach, based on my notion of objectivity, can do much to make

 

'“Whether Short’s theorizing or the ﬂood of racist, nationalist, populationist sentiments had any impact
on birthrates in Britain amongst the colored immigrant, working class population is beyond the purview
of this project. But it is an important question that needs to be investigated.

72

medical theorists aware of their work as a value-laden enterprise, and thus, more
aware and critical of their work than they might be otherwise.

Now, to return to the Williams Obstetrics' menstruation-as-pathology theory.
Interestingly enough, the populationist concerns that appear to have motivated Short’s
theorizing (especially his endorsement of menstrual suppressant contraceptives, as
opposed to iron tablets or better nutrition or mood stabilizers, as 'treatrnent' for the
problems of anemia and PMS correlated with monthly menstruation) are also present
in Williams Obstetrics. Much like Short, the editors of this obstetrics textbook
construe “over-population” to be “the greatest hazard to the health and environmental
and economic future of humankind.”165 Whilst they do not identify Asia and Africa by
name as regions with high population growth, they note with alarm that “[t]he
population doubling time in some countries today is believed to be less than 20 years,
perhaps as low as 12 or 15. The population of the world has already passed the 5
billion mark!”"’6

Disturbing as the endorsement of universal use of menstrual suppressant
contraceptives by Short and the editors of Williams Obstetrics is, it is reassuring to
note that their position seems not have received much uptake amongst the larger North
American medical community. Not all gynecological and obstetrics textbooks discuss
the similarity between women’s reproductive physiology and that of non-human

primates, and those that do, such as Kistner's Gynecology & Women 's Health, do not

go on to posit the reproductive biology of non-human primates as the norm that human

 

'65 Williams Obstetrics, 1993, ll. Presumably, economic exploitation, sexism, racism, industrial
pollution, militarisation are not key threats to human well-being.
“Williams Obstetrics, 1993, ll.

73

females ought to conform to. '67 However, it is troubling to think that in at least some
North American medical schools, future generations of gynecologists and obstetricians
are cutting their teeth on Williams Obstetrics. One can only hope that they understand
the model of menstruation as an endocrinopathy as a theoretical construct and not as
the truth about women.

Although the populationist anxiety expressed in the Williams Obstetrics
menstruation-as-pathology theory may appear to be an idiosyncrasy of the editors of
that textbook that is not shared by the American medical community, I believe it
reﬂects certain cultural concerns. (I discuss them below in section 3.6 while analyzing

another theory that medicalizes women's periodicity.)

3.4 Coutinho and Sega] 's Menstruation-as-Pathology Theory

Distinct from the attempt in Williams Obstetrics to characterize monthly
menstruation as a pathological evolutionary development, necessitating the uniform
use of menstrual suppressant contraceptives, in the last few years another movement
construing women’s periodicity as a health risk has emerged. Its proponents are
Elsimar Coutinho, a Brazilian gynecologist, and Sheldon J. Segal, an American
biochemist and embryologist. In Is Menstruation Obsolete (1999), they claim that
unless contemplating pregnancy all females of childbearing age ought to use menstrual
suppressant contraceptives because “[r]ecurrent menstruation is unnecessary and can

be harmful to the health of women. It is a needless loss of blood.”'68

 

167

Kistner's Gynecology & Women's Health, edited by Kenneth J. Ryan, Ross S. Berkowitz, Robert L.
Barbieri, Robert L. Barbieri MD. and Andrea Dunaif, Mosby, Inc, 1999, 25.
'68Coutinho and Segal, IMO?, 159.

74

Foremost and strongest amongst their many reasons for ‘treating’ monthly
menstruation with menstrual suppressant contraceptives are the arguments that it is
responsible for PMS and it both causes and compounds iron-deﬁciency anemia.

Below, I evaluate these two arguments. '69

3.5 Coutinho and Segal ’s Iron-Deficiency Anemia and PMS Arguments
Coutinho and Segal claim that iron deﬁciency anemia is a serious problem for
developing nations.170 They contend that the female population in these parts of the

world is particularly compromised by anemia because of menstrual blood-loss:

For countless malnourished women around the world already suffering from
chronic anemia, the blood loss associated with normal menstruation causes
depletion in iron stores that can worsen the condition. For these women,
anemia must be recognized as a potentially serious consequence of repetitive

menstruation. 171

As a solution to the problem of iron-deﬁciency anemia in these parts of the world, they
suggest the use of menstrual suppressant contraceptives by all females of childbearing

age:

The problem of anemia in less afﬂuent countries of eastern and southern

Europe and in many developing countries remains much worse (than that in the

 

I69I focus on these two arguments because they are their strongest arguments.
”°Coutinho and Segal, IMO?, 93, 160-1.
"'Coutinho and Segal, 11140.7, 92.

75

richer, more developed nations). Considering that the monthly loss of blood is
absolutely needless and that the treatment of anemia signiﬁcantly increases the
cost of the already overburdened health services of these countries, the
suppression of menstruation would be an important public health measure, as

well as a health beneﬁt to individual women.’72

There are numerous problems with this proposal. First, the predominate cause of iron-
deﬁciency anemia amongst the poor (men, women, and children) of the global South
is inadequate sanitation facilities, resulting in high incidence of hookworm disease.I73
Assuming that Coutinho and Segal would not be opposed to treating the root cause of
iron-deﬁciency anemia by providing the compromised populations with adequate
sanitation facilities, iron tablets and treatment for hookworm disease (the latter

174

solution, according to UNICEF, cost only a few US. dollars per years per person),

it is unclear how suppressing monthly menstruation is any part of a sound solution

 

I72Coutinho and Segal, ”140?, 160-1.

mAccording to the US. Department of Health and Human Services, “Hookworm eggs are passed in
human feces onto the ground where they develop into infective larvae. When the soil is cool, the worms
crawl to the nearest moist area and extend their bodies into the air. They remain there - waving their
bodies to and fro — until they come into contact with the skin, usually on a bare foot, or until they are
driven back down by the heat. Hookworm is widespread in those tropical and subtropical countries in
which people defecate on the ground and soil moisture is most favorable” (“Parasitic Roundworm
Diseases,” National Institute of Allergy and Infectious Diseases, National Institutes of Health, US.
Department of Health and Human Services. Source: www.niaid.nih.gov/factsheets/roundwor.htm
(April 22, 2004)). The hookworm larvae once inside their human host cause trouble for them when the
"... worms attach their mouths to the lining of the small intestine and suck the person's blood... Once
established within the intestine, the adult worms can cause abdominal pain, decreased appetite, diarrhea,
and weight loss. Most importantly, the worms suck between 0.03-0.2 ml of blood per day. When a
worm moves from one area of the intestine to another, it detaches its mouth from the intestinal lining,
leaving an irritated area that may continue to bleed for some time. This results in even further blood
loss. A single adult worm can live for up to 14 years in a patient's intestine. Over time, the patient's
blood loss may be very signiﬁcant. Anemia is the most serious complication of hookworm disease,
progressing over months or years. " ("Hookworm Disease," Health A to Z. Source:
http://www.healthatoz.com/healthatoz/Atoﬂency/hookworm_disease.jsp. Downloaded: 18 May 2006). I
owe this point to Dr. 1. Khan.

l7"Source: www.unicef.org/sowc98/pane120.htm (7th April 2004)

76

(and quite clear how awesome 3 potential market the global South can be for
menstrual suppressant contraceptives -more on this later).

Coutinho and Segal also argue that menstrual suppression should be adopted
by women in wealthy, industrial nations, such as the US, because, according to a
Journal of the American Medical Association article, about 7.5 million young females
in the US. are iron-deﬁcient.I75 They take this as evidence of a direct causal
connection between monthly menstruation and iron—deﬁciency. However, their
attempt to marshal this study in support for their position is problematic because the
authors of the research project in question came to a conclusion that was inconsistent
with Coutinho and Segal’s thesis. In “Prevalence of iron deﬁciency in the United
States,” Anne Looker et a1. argue that “iron deﬁciency and iron deﬁciency anemia are
still relatively common in the Unites States among women of childbearing age,
especially those who are black or Mexican American, poor, and have 12 or fewer
years of education or 4 or more children.’”76 Looker’s conclusion (that the incidence
of iron-deﬁciency and iron-deﬁciency anemia appears to vary with the race, number of
children and education and poverty level of their female research subjects, rather than
just their sex and fertile status) is at odds with Coutinho and Segal’s simplistic

analysis.

 

”58y means of an extensive search of the JAMA archives on the subject of anemia, I was able to
identify the article in question as Coutinho and Segal failed to cite the authors, the title and the date of
publication of the article. This is true for a number of studies that Coutinho and Segal mention but do
not adequately reference. For instance, Coutinho and Segal cite US National Sleep Foundation research
project on PMS related sleep disturbances but fail to adequately identify the study (Coutinho and Segal,
IMO?, 68). They also claim that the Center for Safety Studies in the US has determined that due to
cognitive impairment of women experiencing PMS “the forty-eight hours preceding menstruation are
the most dangerous because this is the time when most accidents occur” but provide no additional
information about this organization (Coutinho and Segal, IMO?, 74). I was not able to locate these and
a number of other studies that they mention even after a careful and fairly elaborate web search.
I76Looker, A.C., Dallman, P.R., Carroll, M.D., Gunter, E.W., Johnson, C.L. Prevalence of iron
deﬁciency in the United States. JAMA. Vol. 277, Iss. 12, Mar 26, 1997.

77

The other argument that Coutinho and Segal use in support of their thesis
focuses on the phenomenon of PMS. Citing the work of Katharina Dalton'77 and
several others who purport to document women’s impaired state during the pre-
menstruum,178 Coutinho and Segal attempt to argue that suppression of ovulation by
means of menstrual suppressant contraceptives is the “most logical rationale for
resolving the discomfort of PMS at its source.”179 Citing a study conducted on only 20
women,180 who showed improvement in their symptoms (which included sadness,
bloating, food craving, irritability, etc) after being put on a regimen of ovulation
suppressants, Coutinho and Segal try to argue that because menstrual suppressant
contraceptives alleviate PMS symptoms in some women who suffer from the
condition, all females of childbearing age ought to use menstrual suppressant birth-
control. This argument does not hold much water because it makes no sense to ‘treat’
someone for a condition she does not have.

Coutinho and Segal also attempt to appeal to feminists by citing the work of
Emily Martin and Sophie Laws on PMS. In The Woman in the Body, Emily Martin
challenges the predominant negative reading of PMS in Western cultures. She argues
that such a reading is a function of the patriarchal, capitalist industrialist complex.
During the pre-menstruum, any expression of anger or resistance by women against
their oppressive reality is attributed by the establishment to an alleged physiological

ﬂaw in these women, rather than treated as a warranted critique of the large social

 

mCoutinho and Segal, 1999, 73-80. See above for an analysis of Dalton’s methodology.

'"Here again, Coutinho and Segal do not adequately cite their reference(Coutinho and Segal, 1999, 68
and 74). These failures and the blind faith they expect from their readers reﬂect their assurance in the
justiﬁcation of their own epistemic authority, not an approach compatible with the conception of
women as rational agents, interested in and capable of making informed health decisions.

'79Coutinho and Segal, 1999, 72.

'80Schmidt, Peter 1., Nieman, Lynette K., Danaceau, Merry A., Adams, Linda F., Rubinow, David, R.
“Differential Behavioral Effects of Gonadal Steroids in Women with and in those without Premenstrual
Symptoms.” New England Journal of Medicine, Jane 22, I998.

78

order. Martin also worries about the use of this sort of logic to justify violence against
women by their male partners in the domestic context. In Issues of Blood, Sophie
Laws argues that men’s negative attitude towards the pre-menstruum and menstruation
as well as their commitment to sexist gender stereotypes about women has played a
signiﬁcant role in shaping women’s experience of the physiological and psychological
changes preceding menstruation.

Although Coutinho and Segal claim to engage with Martin’s and Laws’
analysis, I do not believe that they actually do so because, on the heels of a brief
synopsis of Martin’s and Laws’ work, they write, “Clearly, PMS can be a serious
problem for the patient and for those around her, but it should not be accepted as
inevitable.”'8' To claim that PMS is the problem, whilst (supposedly) acknowledging
the merit of Martin and Laws’ analyses is to utterly miss the point of their work. It
could also be argued that Coutinho and Segal misrepresent Laws’ work by
juxtaposition's her analysis about men’s negative attitude towards the pre-menstruum
and menstruation shaping women’s experience of the premenstruum with claims by
researchers (whom Coutinho and Segal do not identify) who contend that women with
PMS are abusive and neglectful of their children, without making it clear that Laws
herself makes no such claim about women with PMS."’2

Coutinho and Segal’s failure to treat seriously feminist analyses of the
patriarchal construction of PMS can be understood in light of their comment about
women who do not view menstruation as a wholly negative experience. They seem to
consider most such analyses as the emotional outpouring of women who suffer from

PMS and experience relief with menstruation. They write, “Articles describing

 

I"'Coutinho and Segal, 1999, 71.
'82Coutinho and Segal, 1999, 71.

79

menstrual bleeding as being good for women’s health have appeared in magazines and
newspapers, frequently written by women with PMS, who experience relief from these
symptoms with the arrival of their menstrual ﬂow?”83
Coutinho and Segal’s willingness to espouse patently weak arguments seems
to speak of a commitment to the idea that the female body is intrinsically ﬂawed. In
fact, this notion appears to motivate them to argue that delaying menarche in young

girls (by ‘treating’ them with menstrual suppressant contraceptives) might be a

solution to the problem of incest and rape:

In Brazil, almost 30,000 pregnancies in girls age 10 and II were reported in
1995. Family members and friends impregnated most of these girls. A girl’s
biological father was often the sexual assailant. The direct solution to this
problem, which should be applied forcefully and without compromise is to
control the offenders or to remove them from the home A late menarche is
no guarantee of protection, but it delays her pubertal change, the young girl
may be less likely to be targeted and victimized by sexual harassment and

abuse. '8’

To suggest delaying adolescence, including menstruation, as part of the solution to the
problem of rape and incest reveals a deep commitment to the idea that the sexually
mature female body is responsible in some way for the violence that is visited upon it

by rapists and sexual abusers.

 

'83Coutinho and Segal, 141.
l8"Coutinho and Segal, 1999, 162.

80

In general, Coutinho and Segal rely on methodologically suspect research and
misread studies and feminist scholarship to make shoddy arguments characterizing
women as intrinsically ﬂawed. But, like Short and the editors of Williams Obstetrics,
they identify themselves as motivated by and committed to women's well-being and

autonomy. Coutinho and Segal write,

Is Menstruation Obsolete? argues for menstrual suppression based on
improving women 's medical health. The discussion does not involve wresting
control of women's bodies in order to place it in the hands of doctors, nor
exhortations to conceal evidence of menstruation, nor attempts to suppress or
erase women's femininity. Instead, it presents a fresh view of menstruation,
ultimately concluding that regular menstruation over the course of a woman's
reproductive years is simply not necessary from a medical perspective. It is
then up to the reader to decide whether these arguments outweigh her personal

feelings about menstruation (my italics). ‘85

Coutinho and Segal's decision to advocate menstrual suppressant contraceptives as the
treatment for PMS and anemia even though, in North America, the standard treatment
for anemia is iron tablets and for PMS it is psycho-pharmaceuticals (such as anti—

depressants and anti-anxiety drugs), diuretics, or hormonal therapies is puzzling.186 I

believe examining the institutional and cultural context of their theory through the

perspective of the disenfranchised, nationally and internationally, might prove fruitful

 

'ssCoutinho and Segal, ls Menstruation Obsolete?, x.
'“Dickerson, L.M. "Premenstrual Syndrome," American Family Physician 15 April 2003; 67(8): 1743-
52.

81

in answering that question as it did in the case of Short's theory.I87 So, mirroring my
analysis of Short's theory, I analyze the social and institutional framework of Coutinho
and Segal's theory from multiple marginalized perspectives. (As mentioned earlier, I
bracket discussing this strategy until chapter ﬁve in the interest of not disrupting the

ﬂow of the case analysis.)

3. 6 Examining the Cultural and Institutional Context of C outinho and Segal ’5
Theory Using Marginalized Perspectives

Sheldon Segal is part of the Population Council, a transnational non-proﬁt
organization with a populationist agenda, and Elsimar Coutinho has also worked for
the Population Council but his association with it has been much more limited.'88

As a senior key ﬁgure at the Population Council, Segal has been inﬂuential in
guiding the development of various forms of contraceptive devices, including intra-
uterine devices and sub-dermal hormonal contraceptive devices, such as Norplant and
Jadelle. He has also written a number of articles on the problem of over population.
His book Under the Banyan Tree: A Population Scientist s Odyssey (2003) reﬂects his
deep engagement with the issue. Segal, by virtue of his prominent institutional

position, has also been instrumental in shaping global family planning programs by

 

mAs discussed earlier in section 3.2 of this chapter, given that various forms of oppression may be
interconnected, as part of my strategy for identifying values shaping medical theories, 1 advocate
examining those theories from multiple marginalized perspectives, including the oppressed group or
groups that are directly impacted by those theories.

1"’Coutinho was instrumental in the development and testing of Depo-Provera (Coutinho and Segal,
1999, 8-9).

82

serving in an advisory capacity to the World Health Organization, the United Nations
Population Fund, the World Bank, the European Parliament, and the US. Congress.189

Established in 1952, the New York based Population Council is the brainchild
of John D. Rockefeller.190 Its mission is to improve the material condition of humanity
as well as strive towards a humane, equitable, and sustainable balance between people
and resourcesm by developing and encouraging the use of contraceptives in poverty
stricken areas of the world with high population growth.

The Council’s web-site characterizes Rockefeller’s interest in the issue of
population growth as purely humanitarian, arising out of his travels through poverty
stricken, densely populated regions of South and EastAsia.192 Thomas Shapiro
indicates that a 1950 Rockefeller Foundation report with a Malthusian analysis of the
relationship between population, human welfare, social change and the threat of
political upheavalI93 signiﬁcantly shaped Rockefeller’s views on population growth
amongst the global poor. The report recommended that human fertility ought to be
reduced “‘so that growth can be kept at the least dangerous possible’ (quoted in
Shapiro, 64).”194 In the wake of that report, in 1952, along with like-minded
industrialists and researchers, Rockefeller organized a conference where the need for
an organization to address the ‘population problem’ was articulatedm At its

inception, the trustees of the Population Council included Frederick Osborn

 

189Source: http://wwwpopcounciLorg/staff/bios/ssegalhtml (April 24, 2004). According to Eugenics

Watch’s “Activities Database: Directors: Last Name Beginning M-Z,” Segal served as the director of
the American Eugenics Society between 1969-80 and 1987-92 (Source:
http://www.africa2000.com/ENDX/aedir-m.htm (June 26, 2004)).

1“Member of the American Eugenics Society since 1930 (Source: http://www.africa2000.com/ENDX/
(July 1, 2004)).

l9'Source: wwwmpcouncil.orglabout/abouthtml (April 18, 2004).

”ZSource: www.popcouncil.org/about/about.html (April 18, 2004).

'93Shapiro, 1985,64.

‘9“Shapiro, 1985,64.

'9’Shapiro, 1985, 65-6.

83

(Advisory Council Member, American Eugenics Society, 1928-81),196 Frank Notestein

’97 and representatives of some of the

(Director, American Eugenics Society, 1950-56)
nation’s wealthiest industrialist families, including Rockefeller, Mellon, and Ford.

The Council’s mission statement suggested that high fertility rates were the
crucial cause of widespread poverty in Africa and Asia, endangering the survival of
the species and occasioning global economic and political instability. It failed to
appropriately acknowledge that the poverty pervasive in the 19403 and 50s in Asia and
Africa was the product of complicated interaction between local and global multiple
systems of oppressions, including the systematic exploitation of the labor force and
natural resources of these regions by colonizers. Working in conjunction, these factors
gave few the opportunity to escape poverty. Even today, the Council remains
committed to its original analysis, labeling high population rates as the critical threat
to the well being of humanity.198 It fails to acknowledge that the present cause of
poverty and political instability in developing nations is attributable to a number of
factors, including corrupt political regimes, interaction between local and global
multiple systems of oppression, systematic exploitation of natural resources and labor
by transnational corporations, unjust trade agreements beneﬁting the global powers
and transnational corporations, mis-guided developmental policies and massive
military budgets.

The shortcomings of the Council’s agenda have in no way limited its ability to

marshal the support of various non-govemmental and governmental agencies across

 

I96Eugenics Watch. “Activities Database: Ofﬁcers.” Source: www.afric32000.com/ENDX/aeoff.htm
(June 26, 2004).
'97Eugenics Watch. “Activities Database: Directors: Last Name Beginning M-Z.” Source:
www.africa2000.com/ENDX/aedatahtm (June 26, 2004).

Source: www.copcouncil.org/about/about.html (April 18, 2004).

84

the globe, including, at present, the US. government, the World Bank,‘99 the United
Nations, the World Health Organizations and various governmental entities. In the
interest of providing an account of how the Population Council came to have global
inﬂuence, I focus on the history of its relationship with the US.

Frank Notestein, as Laura Landolt points out, was instrumental in marshaling
the support of the US. government for the Council’s populationist agenda. After
traveling through China in 1949 (on a trip funded by the Rockefeller Foundation),
Notestein, “inﬂuenced by China’s fall to communists, (had) suggested that US
efforts to promote liberal political and economic institutions might be threatened by
political instability and communist expansion amongst developing nations” whose
disaffected rural citizenry was mired in poverty.200 Prior to and in the wake of WWII,
the US. government was deeply committed to the Domino Theory about the spread of
communism?“ Therefore, Notestein’s analysis suggesting that curtailing population
was the solution to preventing the spread of communism would have garnered the US.
administration’s support for the Council.

Bonnie Mass notes that the spread of communism in resource rich nations in
Central America, Asia and Africa was seen as a serious threat by the premiere U.S.
industrialists. The nationalization of mining and various other industries in these
regions of the world would seriously impact the ability of US. industries to obtain raw

material. According to Mass, The President’s International Development Advisory

 

I99The staffers of Population Council routinely serve in advisory and consultant capacity to the World
Bank and other organizations (Population Council, Annual Report 2001, 51). Therefore, it could be
argued that it is because of the inﬂuence of the Council that World Bank has introduced lowered
population growth as a lending term on its loans to developing nations.

°° Landolt, 2003, 134.

20'Roosevelt, Franklin D. “Address by President Franklin D. Roosevelt on July 4, 1941,” source:
http://gurukul.american.edu/heintze/RooseveItl .htm (June 27, 2004) and Truman, Harry, “President
Harry S. Truman’s Address before a Joint Session of Congress, March 12, 1947,” source:
hthwwwya1e.edu/lawweb/avalon/trudoc.htm (June 27, 2004).

85

Board, chaired by Nelson Rockefeller,202 estimated that nearly three-quarters of the
raw materials used in the United States originated in Asia, Africa and Latin
America.203 Given that the Council’s agenda of curbing population growth could help
ensure U.S. industries access to raw material by curtailing poverty and stemming the
spread of communism in Asia, Africa and Central America, it was in the interest of the
US. administration to establish ties with the organization.

Over the years, the collaboration between the Council and the US. government
has ﬂourished, translating into signiﬁcant budgetary support for the organization. In
2000, $41.12 million or 58% of the Council’s budget was covered by monies from the
USN" In 2001, $37.3 million or 53% of its operating budget was covered by the
government.205 In 2002, $37.84 million or 51% of its operating budget was provided
by the US.206

Currently, the vast majority of the council’s budget goes into the development
of new contraceptive devices and into research about successful family planning
programs for the poor. Although the threat of communism no longer substantiates a
government rationale for global population control, the US. continues to support the
Council’s work because it remains committed to the idea that curbing population
growth amongst the poor is key to global economic development and fostering
democracy. In the recent past, as pharmaceutical companies have expressed reluctance

to engage in contraceptive development, citing the risk of product liability lawsuits

 

202Nelson Rockefeller was the chairman of the Advisory Board (1950-51). Sources:
www.infoplease.com/ce6/people/A0842152.html & www.cncvclopedia.com/html/R/RockefelN1 .353
(29 April 2004).

03 Mass, 1976,35.

204Source: www.popcouncil.org/about/arOO/ﬁnancials.htm1 (April 18, 2004).

205 Source: www.popcouncil.org/pdfs/ar2k1.pdf (April 18, 2004).

2("’Source: www.popcouncil.org/about/arOZ/ﬁnancials.html (April 18, 2004). Although the Population
Council may appear to be a relatively small organization that should not be considered the indicator of
the scope of its inﬂuence. Rather its interaction with various entities, such as the UN, the World Bank,
USAID, etc, are a better indicator of its authority.

86

and social controversy, the US. government has taken the onus of supporting- albeit,
indirectly- contraceptive development. Rather than provide monies to pharmaceutical
companies, it funds the Council, a non-proﬁt organization. The development of the
sub-derrnal contraceptive implant, Norplant, can be considered a ‘success’ story (of
sorts) of this approach.

The Population Council invested $23.5 million on researching and $16 million
on introducing Norplant in developing nations. As the groundwork for Norplant
development and marketing was already in place, Leiras Oy, a Finnish company,
purchased the license to manufacture Norplant from the Council and spent an
estimated $23 million in developing the manufacturing protocol. Also, thanks to the
Council’s efforts, Norplant was picked up by Wyeth-Ayerst, a pharmaceutical
company, which introduced it in the American private sector at a cost of $50 million.
As the pharmaceutical giant went on to garner signiﬁcant proﬁts from a product
developed mostly through public funding, the claim of pharmaceutical companies that
it is never proﬁtable for them to enter the contraceptive market does not appear to be
justiﬁed. For instance, sales of Norplant just in the United States during its ﬁrst year
on the market totaled $141 million with 800 devices being inserted in women per day.
By 1993, about 1 million women in the US. were using Norplant.207 Although in

1999, a class action lawsuit was initiated by US. users (because the company had
downplayed the side effects of the product), Wyeth-Ayerst’s parent company,

American Home Products Corporation, settled the case to its advantage.208 It made a

 

207Contraceptive Research, Introduction, and Use: Lessons From Norplant (1998) by the Institute of
Medicine (IOM), 108-10.

208It is worth keeping in mind whether any sort of legal redress was and is available to women who
access Norplant and other contraceptives through family planning clinics for the poor in Third World
countries but were and are not provided with complete information about these products. For that
possibility signiﬁcantly impacts the proﬁt margins of pharmaceutical companies.

87

payment of about only $50 million to approximately 36,000 women. Litigation
analysts have argued that this settlement did not pose much of a burden to the
company given its net proﬁt of $2.5 billion in 1998 (no small amount of which was

attributable to the global sales of Norplant).209

All in all, a number of pharmaceutical
companies found it in their interest to participate in Norplant manufacture and sales
thanks to the relationship between the Council and the US.

The Council’s relationship with the US. has also translated into a symbiotic
bond between the Council and the US. Agency for International Development
(USAID). Using funds provided by various governments, non-govemmental
organizations and private individuals, USAID decides which contraceptive devices to
purchase to supply to family planning clinics for the poor in developing nations.210 It
also funds and directs the training of the staff for these clinics?” The substantial
ﬁnancial support that USAID provides for the Council’s contraceptive development
efforts and family planning program research212 translates into products that USAID
uses to meet its own foundational goals. The development of Norplant and Depo-
Provera as well as their use in family planning clinics for the poor globally, for
instance, served the purposes of both organizations.

Given the Population Council’s history of inﬂuence with the US. government

(especially, USAID) and transnational ﬁnancial institutions, if the Council throws its

full weight behind Coutinho and Segal’s argument for the use of contraceptives that

 

20”“Norplant company agrees to settle suits: Offer to women could top $50 million” by Charles Omstein
in The Dallas Morning News, 08/26/99. Source:
www.legalactionforwomencrglnorplantsettlementhtm1 (April 18, 2004).

'OHartmann, 1987, 256.
2” See “USAID Policy Paper: Population Assistance,” Bureau for Program and Policy Coordination,
USAID, September 1982, 6. Source: www.us_c_1id.gov/our_work/global_health/poplpopulat.pdf (April
25, 2004).
2"“Evaluation of the Population Council's Programmatic Cooperative Agreement with USAID,”
Poptech Report No. 98-132-071 August 1998, vii. Source: www.poptechproject.com/pdf/pcp71sumpdf
(April 25, 2004)

 

88

suppress menstruation, it is not inconceivable that in the name of promoting women’s
health these organizations could inﬂuence the governments of developing nations to
‘encourage’ the wide scale use of such contraceptives by their female populations by
means of family planning programs for the poor. If there is such a push, the ﬁnancial
beneﬁts that would accrue for pharmaceutical companies and for the Council, which
owns the patent and licenses for various contraceptive devices that serve as menstrual
suppressants, are worth taking into account.”3

Whether the use of menstrual suppressant contraceptives universally translates
into better health for women is unclear. In No More Periods?, as part of her critique of
Coutinho and Segal’s work, Susan Rako carefully documents the relationship between
the use of hormonal contraceptive that suppress menstruation (with or without
producing withdrawal bleeding) and the increased vulnerability to the human
papilloma virus (HPV) infection and cervical cancer, along with the other risks
associated with hormonal birth-control devices.214

It could, however, be argued that the decision of women who, under no
pressure from poverty, make informed choices about using hormonal contraceptives
must be respected. But are women in developing nations who access family planning
clinics for the poor provided with information that would allow them to make
informed choices, under conditions where their decisions are not dictated by poverty?
In this regard, it is instructive to look at USAID-World Bank-Population Council

supported family planning clinics for the poor in Bangladesh during the 19805. Betsy

 

2" Of course, the Council would argue that as a non-proﬁt organization it is not motivated by the
possibility of ﬁnancial gain but by its mission “to improve the well-being and reproductive health of
current and future generations and to help achieve a humane, equitable, and sustainable balance
between people and resources.” Source: http://www.ngpcouncil.org/about/about.html (June 27, 2004).
2"‘Rnlco, 2003, 100-39.

89

Hartmann documents appalling abuses and problems with these programs.215 Working
in conjunction with the local government, these family planning clinics used food and
other material incentives to ‘convince’ a desperately poor population to use birth
control, both reversible and permanent. The female clientele were routinely not
provided with adequate information that would allow them to make informed
decisions about contraceptive use. Nor were these women provided with the medical
follow-up and support required for the safe use of various forms of contraceptives."6
Of course, this is not to characterize the women of developing nations as helpless
victims, lacking any agency to speak out against the violation of their human rights.
Local grassroots feminist organizations have successfully organized movements
against abuses perpetrated by these programs.217 But it would be unwise to
underestimate the scope of inﬂuence of organizations, such as the Population Council,
the World Bank and USAID, especially when they identify their policies, decisions
and projects as motivated by concern for women’s health.

In recent years, all three of these entities have been quite vocal in their
opposition to coercive practices in family planning clinics for the poor, which would
seem to suggest a level of genuine concern for the plight of women in poverty-stricken
nations. But whether that commitment has translated into practice is questionable. A
1995 publication of the INFO Project (a USAID funded project) advises family
planning programs for the poor in developing nations to be less than forthright in

discussing possible side effects. According to the report, “Because bleeding changes

 

2”Hartmann, 1987, 208-226.
2”’For an account of the human rights abuses perpetrated in various nations under the auspice of family
planning for the poor, see Hartmann (1987) and Mass (1976).

l7Hartmann identiﬁes various other grassroots feminist organizations in Third World countries that
have spoken out against human rights abuses by family planning programs (Hartmann, 1987, 171-2,
286-96).

90

and weight gain are so common, during counseling all women who choose injectables
should be told of these likely changes. Program managers need to decide what other
side effects to mention based in part on the side effects most often reported by clients.
These decisions should be made with the goal of helping clients to make a fully
informed choice and to use the method effectively and conﬁdently.”218 That the report
recommends that program managers decide which side-effects to mention based on
whether or not it is perceivable to the user allows for the possibility that program
managers may consider themselves at liberty to not mention the risk of cancer, stroke,
and other illnesses that may not be readily apparent to users as caused by the use of
certain contraceptive devices.

I have "read" the cultural and institutional context of Coutinho and Segal's
through the eyes of the disenfranchised. That approach differently illuminates Segal
and Coutinho's work (speciﬁcally, their misreading of research, reliance on dubious
studies, use of shoddy arguments to claim women are intrinsically defective (as
opposed to men), categorization of menstruation as a disease, and espousal of
menstrual suppressant contraceptives as the treatment of choice for PMS and anemia)
than the standard method of assessing theories (based on the logical positivist notion
of objectivity). Although the standard approach for evaluating theories might be
critical of Segal and Coutinho's fallacious arguments and expose their shoddy
methodology for what it is, it would assume that their work was value-free because the
evidence in support of their hypotheses could be intersubjectively veriﬁed. Thus, the

standard method of assessing theories might not be of much help to Coutinho, Segal,

 

2'8 “New Era for Injectables with Counseling Guide and Fact Sheet,” Population Reports, XXIII/2,
August 1995, chapter 4. Source: www.infoforhealth.org/pr/k5/k5chap4.shtml#top (April 20, 2004).

91

or other medical theorists in making them aware of the host of contextual values
shaping particular medical theories.

In contrast to the standard method for evaluating medical theories, my
approach for assessing theories has much more to offer to medical theorists. In
particular, it would allow them to 'see' the values shaping their theories, and thus, they
would be more self-aware and self-critical than Short, the editors of Williams
Obstetrics, Coutinho and Segal appear to be. Adoption of my approach may result in
medical theories that generate representations of human physiology that are better than
the ones that have been constructed so far. For instance, it may result in theories about
women's reproductive physiology that are better than those that have been formulated
by theorists who are unaware of, and thus, uncritical of the contextual values shaping

their work.

3. 7 Conclusion

In this chapter, I analyzed Short et al.'s theories as well as the cultural and
institutional context of their work through the eyes of historically oppressed
populations.219 That approach is part of my notion of objectivity. Using that strategy
meant drawing on the work of theorists that are themselves members of
disenfranchised groups or theorists who may not be part of various marginalized
groups but who have adopted the lens of the marginalized in their theorizing.220 Both

groups are critical of the account of the world that the dominant oppressive order has

 

2'"In chapter ﬁve, I describe this strategy in some detail and consider objections to it.

220Some of those theorists are Emily Martin, Betsy Hartmann, Helen Longino, Bonnie Mass, Sophia
Laws and Laura Landolt (I have cited their work). The other theorists whose work has inﬂuenced my
analysis but whom I have not cited are Ruth Hubbard, Sandra Harding, Jackie Zita, Abby Wilkerson,
Lynde Birke, bell hooks, Marilyn Frye, Patricia Hill Collins, and Donna Haraway.

92

created. The exercise of re-reading the menstruation-as-pathology theories as well as
the cultural and institutional context of those theories through the eyes of the
marginalized reveals that the theories in question were shaped by and reﬂect the
dominant cultural account of the women 's bodies, population growth, scarcity of
resources, poverty, and disease. I have argued that the medicalization of menstruation
in Short et al.'s theories is the product of a complicated interplay between multiple
systems of oppression. Patriarchy was not the sole factor at work in those theories
rather it was acting in concert with capitalist, racist, nationalist, and populationist
concerns.

In espousing that strategy (as discussed earlier in chapter two, section 2.8), I
differ from Longino. While she argues that members of marginalized communities
should be invited to critique theories, she does not speciﬁcally recommended that they
be asked (by the scientiﬁc community) to scrutinize the cultural and institutional
context of theories. Instead, she claims that scientists be aware of the history of the
ﬁeld they are working in the interest of having a critical perspective on it. While that
method might be fruitful (and thus, I endorse it too), I believe my approach has the
potential to generate a different kind of critique than the one produced by scientists
versed in the history of their ﬁeld but who unquestioningly accept the dominant value
system and social reality. Given that my strategy can illuminate the values that shape
theories but which are not located in its concepts or background assumptions, and
given Longino's interest in making visible all contextual values shaping theories, I
believe she would endorse my strategy (of viewing the cultural and institutional

context of theories through the eyes of the disenfranchised).

93

In the next chapters, 1 consider how Christopher Boorse and Tristram
Engelhardt might assess the two menstruation-as-pathologies theories. 1 focus on
Boorse and Engelhardt because their conceptions of disease are diametrically opposed
and represent standard and highly reputed theories in philosophy of medicine circles. I
make the case that their ability to "see" the host of values shaping those theories would
be enhanced if they adopted my conception of objectivity, including my strategy of
viewing theories as well as their institutional and cultural context through the eyes of

the marginalized.

94

CHAPTER FOUR

4. 0 Introduction

This chapter, in a sense, is the culmination of my project”! In chapter one, I
claimed that philosopher of medicine Chrisptopher Boorse's and Tristram Engelhardt's
answer to the question "medical theories objective" was unsatisfactory. In this chapter,
I provide a well developed argument in support of my assessment of their position. My
argument draws on the notion of objectivity I constructed in chapters two and three. It
also relies on the two menstruation-as-pathology cases that I analyzed in the previous
chapter.

With the goals of demonstrating the shortcomings of Boorse and Englehardt's
position and making the case that they ought to adopt my notion of objectivity, I begin
this chapter by laying out Boorse's deﬁnition of disease and his account of theories of
diseases. Then, I consider how he might respond to Short et al.'s theorizing. After this,
I use my conception of objectivity (including the strategy that I use in chapter three to
identify values shaping medical theories) to highlight the shortcomings of Boorse's
account of theories of diseases as well as his (possible) assessment of the menstruation
as pathology theories. Then, I analyze Engelhardt's position using the same three step
approach. I close the chapter by discussing the signiﬁcance of my analysis for the

question motivating my dissertation project.

4.1. Boorse's Deﬁnition of Disease and His Account of Theories of Diseases

 

22'1 say "in a sense"because in the next chapter 1 consider objections to my notion of objectivity.

95

Boorse deﬁnes disease as involving interference in the function typically
performed by the systems and subsystems within the organism belonging to a
particular species, compromising its ability to reproduce and survive. This account of
disease conceives of biological entities as constituted of a number of complex,
interconnected systems, most of which "work together harmoniously in such a way to
achieve a hierarchy of goals."222 Just as the goal of cells is metabolism, elimination,
and mitosis, and that of the heart is blood circulation, the goal of the organism as a
whole is survival and reproduction.223

Boorse holds that his deﬁnition of disease allows him to sidestep two problems
that arise when disease is deﬁned as deviance from statistically normal functioning.
First, if disease is conceptualized as deviation from statistically normal functioning
within a species, benign anomalies (say, in terms of eye color) have to be considered
diseased. And second, deﬁning disease as deviation from statistically normal
functioning means that, more or less, universal phenomena, such as tooth decay could

not be classiﬁed as disease.224

Boorse contends that it is a strength of his deﬁnition of disease that it is
sufﬁciently universal and abstract to be non-norrnative.225 Distinguishing between

strong and weak normative deﬁnitions of disease, he characterizes the former as the

 

222Boorse, DDI, 551.

223Boorse, DDI, 551-2.

22"Boorse, our, 546 and 551.

22Sln the 1975 version of this paper (published in Philosophy and Public Aﬂairs 5 (F all)), he gives a normative
account of illness. However, in the 1983 version of the same paper (published in the anthology, Concepts of Health
and Disease), in an addendum, he recants this distinction, eschewing it as a misguided concession to nonnativism.
He writes. "Among many revisions I would make in this paper today, two are especially important. First, the view
that illness is disease laden with values (i)-(iii) now seems a mistaken concession to nonnativism. Illness is better
analyzed simply as a systemically incapacitating disease, hence no more normative than disease itself. Features (1)-
(iii) are common social evaluations of illness, underlying the sick role. but they are probably no part of the meaning
of ‘illness’." (Boorse. DD], 560) Given that Boorse rejects the distinction that he had drawn between disease and
illness, I treat the two notions as being equivalent for him.

96

view that disease constructs are mere expressions of social disapprobation.226 Weak
normativism, in contrast, classiﬁes various clusters of phenomena as disease if they
interfere in species typical functioning of the organism and are the subject of social

approbation.227

Boorse rejects both normative deﬁnitions of disease. He argues that the
concept of disease that has a strong normative component is untenable because it treats
all and any socially disvalued phenomena, ranging from ugliness to adolescent
pregnancy, as diseased. Borrse also rejects the deﬁnition of disease that has a weak
normative component. He contends it cannot appropriately deal with conditions,
usually classiﬁed as disease, say, an infection, that may be desirable under some
circumstances, say, following an inoculation. To round off his argument against the
two normative deﬁnitions of disease, Boorse contends that if what is classiﬁable as
disease is indeed a matter of social opprobrium, then disease and health become a
matter of public consensus. Given that human consensus about disease and health do
not determine claims about disease and health in non-human animals and plants,228
allowing them to do so in the case of humans is inappropriate because humans are
fundamentally the same sort of entities as non-human animals and plants, regardless of

their complex social reality.

Given that Boorse is committed to a non-normative concept of disease, I
believe he would be opposed to theories of particular diseases that had contextual
values. In other words, his interest in formulating a universally valid, non-normative

concept of disease suggests that he would want theories of diseases to be value free as

 

226Boorse, our, 547.
227Boorse, DDI, 547-8.
22"Boorse, DDI, 548.

97

well. It seems likely that he would reject theories of particular diseases that are laden

with political, social, and ethical values as bad theories.

Having outlined Boorse's deﬁnition of disease and extrapolated from it his
stance on the issue of theories of diseases being encoded with contextual values, now,

I consider how he might assess Short et al.'s menstruation-as-pathology theories.

4.2. Boorse '5 Possible Response to Short '5, Williams Obstetrics ', and Segal-

C outinho ’s Menstruation-as-Patholo Theories
83’

Short contends that menstruation must be regarded as a pathological
evolutionary aberration because (a) human females are primates and females of other
primate species do not menstruate, and (b) human females who menstruate may
experience PMS and anemia. As Boorse deﬁnes disease (as interference in the
function typically performed by the systems and subsystems within the organism
belonging to a particular species, compromising its ability to reproduce and survive), I
believe he would reject Short's claim (a) for categorizing menstruation as a disease on
the grounds that the decision to classify a particular phenomenon as a disease must be
decided without reference to the question whether that phenomenon manifests itself in

other species.

However, Boorse might consider Short's claim (b) as necessary and sufﬁcient

reason to categorize women's periodicity as a disease, provided Short could make the

98

argument that PMS229 and anemia compromise women in terms of their ability to
reproduce, and possibly, survive. (To that end, Short would have to marshal research

that was of a better quality than Dalton's.)

Boorse might also accept the argument made by the editors of Williams
Obstetrics characterizing monthly menstruation as a pathological condition. They
contend women's periodicity is an endocrinopathy that is responsible for PMS -a
universally socially debilitating condition. If they were to claim that it impairs
women's ability to reproduce or survive, Boorse would recognize monthly

menstruation as a disease.

Boorse might also concede to Coutinho and Segal's argument for considering
women's periodicity a disease. They claim monthly menstruation should be considered
a pathological condition because it causes PMS and anemia in a signiﬁcant number of
women. Assuming that anemia impacts one's ability to reproduce and survive, and
supposing that Coutinho and Segal could make a strong argument for the claim that
PMS also impacts women's survival and reproductive capabilities, Boorse would grant

their argument for medicalizing menstruation.

In the next section, I use my notion of objectivity to illuminate various

shortcomings of Boorse's position.

 

229He would probably argue that PMS impairs women's ability to function well in personal and professional

contexts, compromising their capacity to reproduce, and eke out a good existence for themselves.

99

4.3 The Significance of My Notion of Objectivity for Boorse's Account of Theories

Of Diseases And His (Possible) Assessment Of Short Et Al. ’5 Theories

In chapter two, I made the case that objectivity should be understood as a way
that knowers could choose to engage with the world. It required that epistemic agents
concede among other things, that all theories are value laden insofar as they are
expression of the interests and concerns of the epistemic communities that constructed
them and that they should invite and respond appropriately to criticism about theories

and research projects.230

If Boorse were to adopt my notion of objectivity, he would have to
acknowledge that all medical theories are normative. He would have to rescind his
commitment to the idea that medical theories can and should be objective (i.e., value-
neutral), otherwise he would be making the same mistake as the logical-positivists.
The belief that theories could be and should be denuded of value claims is premised on
the idea that knowers could utterly detach themselves from their social context as they
theorize. I have argued that conception of the knower is unrealistic because humans
can only engage in knowledge building activities if certain social pre-conditions exist.
Community membership is a necessary precondition for language development,
acquisition, and formulation of beliefs, values, and interests, thus, individuals can
know only as members of epistemic communities. Given that communities have
values, beliefs, and interests, and individuals know only as members of communities,
no theory - be it scientiﬁc or non-scientiﬁc- can lay claim to being absolutely value-

free, in the sense of having being constructed by a knower who is detached from all

 

230This is an abbreviated account of my conception of objectivity that is relevant to my present purpose.

100

contextual values.23 ' By dint of that reasoning, Boorse would not be justiﬁed in
positing value-free theories of disease as a realizable ideal nor would he be warranted

in assuming that 'good' medical theories are value-free.

I would also urge Boorse to identify the contextual values shaping and
endorsed by particular theories of disease using the strategies I have identiﬁed. To that
end, he would ﬁnd it useful to identify the value-laden background assumptions
mediating the hypotheses-evidence relationship of particular theories of disease.232 In
the case of the menstruation-as-pathology theories, Boorse would have to begin his

assessment of Short's233

and Coutinho and Segal's theories by ﬂushing out the
background assumptions underlying their work. Short, for instance, hypothesized that
monthly menstruation is an evolutionary aberration that is pathological that ought to
be treated by means of "a non-steroidal contraceptive that would allow a woman to
return to the reproductive state that was the norm for our primitive ancestors-

amenorrhoea” (Short, 1976, 20). A5 evidence in support of that hypothesis, he made

the following claims:

1. Monthly menstruation is the product of civilization (i.e., the agricultural
revolution).

2. Females of other primate species do not menstruate on a monthly basis.

3. Females of primitive hunter-gatherer tribes such as the! Kung of the Kalahari

Desert do not experience monthly menstruation.

 

23'Nclson, WK, 315.
232See section on Longino in chapter two for a discussion of this strategy.
233As the argument in Williams Obstetrics is a truncated version of Short's 1 do not treat it separately from Short's.

101

4. Monthly menstruation in human females is correlated with the incidence of
certain forms of cancer, premenstrual syndrome (PMS) that impairs women's
ability to function well socially, and blood loss, which seriously compromises

malnourished women in developing nations (Short 1976).

The key background assumptions mediating between Short's hypothesis and evidence
are, ﬁrst, PMS is a purely biological phenomenon caused by the chemical changes
preceding menstruation.234 Second, human females ought to conform to the
reproductive norm for other female primates; not doing so causes anemia and PMS.
Third, the cancers correlated with monthly menstruation are not attributable to any
environmental factors. Fourth, women in primitive societies (like the females of other
primate species do not menstruate monthly) do not experience the same incidence of
cancers correlated with monthly menstruation. And ﬁfth, the theory of evolution
holds. Although Short does not acknowledge these background assumptions, they
make his argument possible; there is nothing about the evidence claims in of
themselves that necessitate the conclusion that women's periodicity is an evolutionary
aberration that is pathological, necessarily requiring treatment with menstruation

suppressant contraceptives.

Boorse could take Short to task over a number of these background
assumptions. He could ask him to provide data about the incidence of various forms of
cancer in women in primitive societies and females of other primate species. Boorse

could also argue that Short's background assumption that human females ought to

 

23"That point is debatable because there is some evidence that at least in part women's experience of the
premenstruum phase of their menstrual cycle is determined by cultural factors (Ross, L.E. "A
biopsychosocial approach to premenstrual dysphoric disorder." Psychiatric Clinics of North America.
Sep 2003; 26(3) and Johnson, Thomas M. "Premenstrual syndrome as a Western culture-speciﬁc
disorder." Culture, Medicine and Psychiatry. Vol 1 1(3) Sep 1987. )

102

conform to the reproductive physiological norm for other female primates reﬂects a
sexist bias. While Short acknowledges that relative to the incidence of abnormal
spermatozoa in the semen of males of other primate species, the semen of human male
contains a large percentage of morphological abnormal spermatozoa, he makes no
effort to argue that this aspect of human male reproductive physiology should be
categorized as an evolutionary aberration that is pathological. This sexist bias in favor
of men must not be dismissed as Short's idiosyncratic belief because it resonates with

and echoes the larger cultural belief that women are more animal-like than men are.235

Using my notion of objectivity (speciﬁcally, the analysis of the hypotheses-
evidence relationship entailed by it), Boorse could also criticize Coutinho and Segal's
theory on the grounds that it implies that menstruation is an evolutionary development
that compromises women. But that argument wouldn't go far because Coutinho and
Segal's thesis focuses primarily on PMS and anemia to justify the claim that women's
periodicity should be medicalized. Boorse could call to the carpet Coutinho and Segal
for the poor quality of their research methodology. But if Coutinho and Segal were to
marshal better research and improve their methodology, Boorse might have to assent
that monthly menstruation is a pathology. However, before conceding to their
argument, I believe he ought to view their theory as well as its cultural and
institutional context from the eyes of the marginalized. In chapter three, using that
strategy, I argued that Coutinho and Segal's theory must be understood as the product

of the contextual values embedded in their theories (i.e., sexist bias) as well as their

 

235This should not be read as an argument for creating theories that medicalize species typical aspects of
men's reproductive physiology. Rather my point is that Short et al.'s theories are value laden. I also want
to draw attention to the value laden nature of all theories, including medical theories. That is not to say
that all (value laden) medical theories are on par. Rather they should be assessed in terms of their
epistemic merits as well as the values that shape them and the purpose they serve.

103

cultural and institutional values, speciﬁcally, racist, populationist, nationalist concerns.
While I do not believe that a medical theory should be rejected just because it is
encoded with contextual values, I do hold that theories that are shaped by sexist
values, such as Short et al.'s theories, should not be viewed as value neutral and
endorsed uncritically. What Boorse would have to say about this issue is unclear given

that (I have argued) he seems to believe medical theories should be value neutral.

Next I discuss Englehardt's account of concept of disease as well his
conception of theories of particular diseases and his possible response to the

menstruation as pathology theories as it presents an interesting contrast to Boorse.

4. 4 Engelhardt's Conception of Disease and His Account of Theories of Diseases
Engelhardt uses the notion of functioning proper to humans as a criterion for
distinguishing between health and disease.236 He also contends that theories of
diseases identify clusters of phenomena correlated with impairment in functioning
"held to be proper (however that is to be determined) to humans, or a state of affairs
including pain that does not contribute to a proper human function, or a state which is
characterized by deformity or disﬁgurement."237 On that account, speciﬁcally the
claim "impairment in functioning," it would appear Englehardt subscribes to a concept
of disease that is similar to the one Boorse is committed to. But it is because
Engelhardt leaves open how impairment in function is to be determined, it seems that

he might believe that what counts as disease might have a cultural component. That

 

23"’lsngelharclt, 113, 261.
237Engelhardt, IE, 261.

104

reading of Engelhardt's deﬁnition of disease is reinforced by his claim that theories of

238 are social attempts to correlate a variety of phenomena "for the purposes of

diseases
explanation, prediction, and control."239 That suggests Englehardt might not ﬁnd it
troubling if deﬁnitions of disease were normative concepts. Boorse, as I argued earlier,

would ﬁnd that idea unacceptable.

Understanding theories of diseases in the way Engelhardt does has two
advantages. First, all diseases do not have to be treated as real entities with distinct
etiologies. According to Engelhardt, treating diseases as a real entities with distinct
etiologies is problematic because diseases, such as cancer and asthama, have a
relational nature. They do not ﬁt into the subject-predicate mold that is presupposed
by the conceptions of disease as real entities with distict etiologies. Diseases like
cancer and asthama are the manifestation of a complicated relationship between
various factors that range from the physiological to the genetic to the psychological to
the sociological: "Diseases such as asthama, cancer, coronary artery disease, etc., are
as much psychological as pathophysiological in that the likelihood of such illness is
closely bound to experienced stress and the availability of support for the person

stressed. They are thus socioloigical as well."240

According to Engelhardt, the other advantage of his notion of disease is that it
allows theorists, with different interests, the opportunity to develop a variety of causal

analyses, ranging from genetic to metabolic to psychological to social, of the

 

238Although Engelhardt speaks of "notions of disease," I believe he means "theories of various diseases" rather than

"concepts of disease." 1 am led to this conclusion because an account of the cluster of phenomena termed a disease
usually requires a fairly elaborate model (which has predictive prowess); it is arguable whether concepts or notions.
given their rather limited explanatory scope, are up to the task. This is, of course. a loose and incomplete
description of the difference between theories and concepts.

23"Engelhardt, CHD, 39.

24"Ir-:ngelharclt, CHD, 37.

105

phenomenon in question, without having to commitment themselves to understanding

it in a one-dimensional, reductivist way?“

Engelhardt contends that theories of diseases are not value-free; rather, they
reﬂect particular cultural norms. He makes this point by tracing the history of the
pathologization of masturbation during the 19th century in various Western nations.
The masturbation-as-disease theory gained currency because of pre-existing cultural
values and beliefs about sexual activity. Those background assumptions (to use Helen
Longino’s terminology) gave shape to what 19th century medical practitioners and lay
persons took to be evidence for the hypothesis that masturbation was a disease. In
support of his account of theories of diseases, Engelhardt also points to medical
theories of drapetomania and dysaethesia aethiopis as problematic, overt examples of
value-laden theories of disease. During the 18th century in the slave-owning states,
slaves who tried to run away were pathologized by the medical establishment as
afﬂicted with drapetomania and those who refused to abide by the will of the slave
owners and overseers were categorized as suffering from dysaethesia aethiopis.

Elaborating on his claim that theories of particular disease are value-laden,
Engelhardt notes that a variety of different sorts of values may play a role in disease
constructs, ranging from ethical values to aesthetic values (ideas about the ideal
human form) to epistemic norms (the simplicity, the explanatory prowess and other

epistemic virtues of competing notions of disease).242

Though he argues that particular
theories of disease express socially disvalued phenomena, he does not believe that all

socially disvalued behaviors should be pathologized. His desire to refrain from

 

2“Engelhardt, CHD, 38. It could be argued that Boorse's concept of disease also allows for the construction of

various causal accounts of particular diseases, including genetic, physiological, metabolic, etc.
242Engelhardt, "Ideology and Etiology," (IE), 260.

106

arguing for the medicalization of all socially disvalued behaviors (such as ignorance,
greed, political violence) can be read as an attempt to allow for autonomy, and thus,
moral responsibility.243

Moreover his account of the dominant population’s attempts to pathologize
attempts made by slaves to resist injusticez“ strongly suggests that, in general, he
would not support theories of diseases that denied members of a particular group (who
share a certain arbitrary biological characteristic) the opportunity to engage in self-
deterrnination so as to beneﬁt members of another group. Engelhardt holds that
although theories of disease are value-laden, as a society committed to the principle of
autonomy, medicine should (and usually does) foster individual’s autonomy rather
than undermine it.245 Thus, I believe he regards the medical theories of draptomania
and dysaethesia aethiopis as "bad" theories of disease.

While Engelhardt places a premium on autonomy that does not mean he is
espousing liberatarianism.2’6 He argues that formulating a bioethics that recognizes a
diversity of moral perspectives means acknowledging that, ﬁrst, not all moral
communities subscribe to the same notion of the divine, and second, reason does not
lead all of them to the same moral conclusions. It is because such a bioethics cannot
justify itself by appealing to either a transcendental reason or divine authority that it
must rely for its legitimacy on the consent of the various parties involved in the
formulation of such an ethic and who agree to abide by it. Therefore, for such a

bioethics, autonomy (broadly speaking, the ability to engage in self-deterrnination,

 

243Engelhardt, CHD, 40-1 and The Foundations ofBioethics. 82.

ZMEngelhardt, CHD, 42-3.

"’Engelhardi, CHD, 42.

2“In the preface of the second edition of The Foundations of Bioethics (1996). Engelhardt is at pains to make it
clear that his endorsement of autonomy as a primary value in the ﬁrst edition of F B (1986) ought not be read as a
commitment to libertarianism per se. He contends that although a number of readers of his 1986 edition of F B
made this move, they were not warranted in doing so.

107

including the ability to give consent), by default, becomes primary. In other words,
Engelhardt values autonomy above all other values because of a need to ﬁnd a
common ground for justifying a bioethics that could bridge the gap between a variety
of moral perspectives. However, realizing that the use of the term "autonomy" seems
to encourage readers to misread him as a libertarian, he substitutes "the principle of
permission" for "the principle of autonomy" in his later works.247

Engelhardt conceptualizes health as a "regulative ideal" under girding theories
of disease. The ideal in question is one that represents freedom from psychological
and physiological forces, such as kleptomania and congestive heart failure,
respectively.248

There are problems with Engelhardt’s deﬁnitions of disease and health. Insofar
as he appeals to a notion of functioning proper to humans as a criterion for

249 (and if by that he is appealing to

distinguishing between health and disease states
some sort of statistically normal functioning), he is vulnerable to the charge that his
notion of disease would require the medicalization of phenomenon, such as eye color,
that are a benign statistical deviances. Furthermore, virtually universal phenomena,
like tooth decay, could not be categorized as diseases. Although, Englehartdt does not
appear to have addressed these charges, a response could be formulated on his behalf.
He could respond that his conception of disease as impairment in functioning proper to

humans is akin to Boorse's notion of disease as interference in the function typically

performed by the systems and subsystems within the organism belonging to a

 

2“Engelhardt, PB, 1996, x-xi.
248Engelhardt, CHD, 42.
2’9Engelhardt, 113, 261.

108

particular species, compromising its ability to reproduce and survive.250 But this move
might be problematic because by endorsing Boorse's deﬁnition of disease (with his
commitment to non-normativism), Engelhardt would have to rescind his claim that
theories of diseases are normative constructs. I have argued that is not a tenable

position because all theories are encoded with contextual values.

There is another serious problem with Engelhardt's position. His claim that
particular theories of disease are value-laden is based primarily on an analysis of a few
theories of disease (such as the medical theory of draptomania) and Joseph Margolis'
claim that "medicine in general must subserve, however conservatively, the
determinant ideology and ulterior goals of given socieities, [and that] the actual
conceptions of disease cannot but reﬂect the state of technology, and the social
expectations, the division of labor, and the environmental conditions of those
populations' (Margolis, 252)."25 ' Analysis of a few theories of disease and a
descriptive claim about the 'nature' of disease do not make for a compelling argument
(more on this later). Thus, Engelhardt needs a substantive argument in support of his

position that theories of disease are normative constructs.

Bracketing these concerns for now, below I consider how he might assess

Short et al.'s theories.

 

2”Engelhardt might attempt to evoke Boorse's notion of disease because Engelhardt appeals to a notion
of functioning proper to humans as a criterion for distinguishing between health and disease states
(Engelhardt, CHD, 42) and that notion is very like Boorse's notion of disease as interference in species-
typical functioning of the organism.

2 Engelhardt, IE, 257. It is worth noting that Engelhardt does not mean to commit himself to an
umitigates social construtivist position (see above account of his concept of disease (Engelhardt, IE,
26] and 267).

109

4.5 Engelhardt's Possible Response to Short '5, Williams Obstetrics ', and Segal-
C outinho 's Menstruation-as-Pathology Theories

Short claims menstruation must be regarded as a pathological evolutionary
aberration because (a) human females are primates and females of other primate
species do not menstruate, and (b) human females who menstruate may experience
PMS and anemia. Claim (a) would be of no interest to Engelhardt because, as
discussed above, he appeals to a notion of functioning proper to humans as a criterion
for distinguishing between health and disease states.252 However, he would ﬁnd claim

8‘” and anemia are

(b) quite compelling, provided Short could argue that PM
psychological and physiological phenomena that compromise women's autonomy.
Similarly, if the editors of Williams Obstetrics and Coutinho and Segal were to make
an argument characterizing women's periodicity as a pathological condition that
compromises women's agency, Engelhardt would be compelled to concede their
point.254

But perhaps this analysis is a bit quick. Engelhardt's careful, context-sensitive
assessment of the medical theories of drapetomania and dysaethesia aethiopis suggests
he would be interested in examining the social concerns and context underlying and
motivating Short et al.'s theories. However, he does not outline a method that could be

used to examine theories of disease for the contextual values that might be inﬂuencing

them.

 

351

‘ ‘Engelhardt, IE, 261.

2”PMS is generally understood as a condition that has both a psychological component (for example, moodiness,
irritability, etc) and a physiological dimension (e.g., bloating, cramps). But Short et al. understand it as a purely
physiological phenomenon, attributing the psychological component to hormonal changes characterizing the pre-
menstruum period.

2“Whether they could garner sufficient evidence for their claims about the relationship between menstruation and
anemia remains to be seen.

110

Putting aside that issue for now, let us assume that he is able to identify the
sexist and populationist concerns as the values shaping Short et al.'s work. Given that
he rejected the medical theories of the diseases of drapetomania and dysaethesia
aethiopis as bad theories of disease on the grounds that they were efforts on the part of
the dominant social group to compromise the autonomy of another population, it
might be supposed he would object to Short et al.'s theories because of their sexist
commitments, compromising women's well being. However, it is unclear whether he
would regard the populationist concerns motivating Short et a1. as grounds for
rejecting their theories, unless an argument could be made those concerns are an
attempt on the part of the dominant group to compromise the autonomy of another
people.

In the next section, I use my notion of objecitivity to bring to light some of the
shortcomings of Engelhardt's notion of disease as well as his (possible) assessment of

the menstruation-as-pathology theories.

4. 6 The Significance of My Notion of Objectivity for Engelhardt's Account of

Theories Of Diseases And His (Possible) Assessment Of Short Et Al. 's Theories

Engelhardt believes that all medical theories of disease are value-laden. While
he is correct, (as I noted earlier) the argument that he gives in support of his claim is
weak. He relies on a few historical cases of theories of disease and Joseph Margolis's
observation about medicine. Engelhardt is not justiﬁed in making a universal claim

about the nature of medical theories of disease on the basis of a handful of historical

lll

cases (of theories of disease) and Margolis' claim that medicine serves the ideology

and goals of particular societies as well as the social relations between various groups
of that community and is constrained by the state of technological development of that
society.255 He needs a different kind of argument to motivate his universal claim about

the nature of theories of disease.

I believe the argument that I constructed in chapter two about the communal,
value-laden nature of all knowledge has the wherewithal to serve as justiﬁcation for
the claim that all medical theories of disease (as well as disorders and syndromes) are
normative. No theory can be considered free of contextual values because (as I argued
in chapter two on the basis of Nelson's work on, ﬁrst, the deep connection between
common sense theorizing and scientiﬁc theorizing, and second, the relational and
communally constituted nature of the human self) theories reﬂect the interests, beliefs,
and values of the communities that constructed them.256 By arguing that that holds for
medical theories about disease, Engelhardt would have provided a substantive
epistemological argument to ground his claim that all theories of disease are value-

laden.

The other reason my notion of objectivity should also be appealing to
Engelhardt is that it offers strategies that he could use to identify the values that might
be embedded in particular theories. For instance, he could interrogate the
menstruation-as-pathology theories for value-laden concepts and background
assumptions. As I have demonstrated earlier in this chapter (in the section on Boorse),

how that could be done and how fruitful it could be, I will not repeat that here. I would

 

255Engelhardt, 1E, 257.

256Particular theories are attributed to speciﬁc individuals but given that those individuals know only as
members of epistemic (scientiﬁc and non-scientiﬁc) communities that they are part of, in a deep sense,
theories are the creations of those communities.

112

also urge him to examine the theory as well as its cultural and institutional context
through the eyes of historically marginalized populations as I do in chapter three.
Given the way he analyzes the medical theories pathologizing the desire of slaves to
be free, I believe he might be willing to adopt that strategy. Moreover given his
rejectionof the medical theories of the diseases of drapetomania and dysaethesia
aethiopis. I believe he would regard theories of disease that foster or are complicit in
compromising the autonomy of particular populations to beneﬁt other ones as bad

theories of disease.

4. 7 Conclusion

This chapter, as I mentioned earlier, in a sense, is the culmination of my
dissertation.257 I was motivated to engage with the question "are medical theories
objective?" because I found Boorse's and Englehardt's response to it unsatisfactory.
Drawing on my notion of objectivity, including the strategy of analyzing theories and
their institutional and cultural context through the eyes of historically marginalized
groups, I made the case that Boorse's and Englehardt's stance on the issue whether
medical theories can be value neutral is ﬂawed. I argued that they ought to adopt my
notion of objectivity because it would allow them to construct an answer to the
question of the objectivity of medical theories that was informed by actual human

knowledge building practices (as opposed to an answer that was based on

 

2”I say "in a sense" because in the next and ﬁnal chapter, I do more work on my notion of objectivity

by addressing some objections to it.

113

misconceptions about those activities or was uninformed about those practices). That

answer would be that medical theories can't be free of contextual values.

I made the case that espousing my conception of objectivity would mean that
Boorse would have to give up the idea that medical theories could be non-normative.
In contrast, for Engelhardt adopting my notion of objectivity would not have such a
severe consequence. However, he would have to amend the argument that he gives in
support of his position. As I explained above, it does not have the ability to serve as
justiﬁcation for his claim that all theories of disease are value laden. I have argued that
he ought to use my argument about the social, value laden nature of all knowledge
building enterprises to motivate that claim. Moreover, I have made the case that both
Engelhardt and Boorse ought to use my strategies for bringing to light values at work

in medical theories as without them they might not see those values.

The account of objectivity that I have formulated does not categorical prohibit
the medicalization of species-typical aspect of men's or women's physiology.258 But
what it does do is, ﬁrst, it requires that medical theorists recognize their work to be a
value-laden activity, and second, it provides strategies (discussed in chapters two and
three) that could help them recognize the contextual values shaping particular medical

theories, and thus, be more critical and reﬂective about the theories that they devise.

In the next chapter, I respond to two serious objections to the notion of

objectivity that I have constructed.

 

25"However, I do think the two menstruation-as-pathology theories discussed in chapter three are bad
theories. They should be rejected on the grounds of the analysis that I have provided of them using my
notion of objectivity.

114

CHAPTER FIVE

5. 0 Introduction
In this ﬁnal chapter, I describe and respond to two objections to my notion of
objectivity, speciﬁcally, the strategy that medical theories be critiqued from

perspective of the marginalized communities. Then, I conclude the dissertation.

5.1 Critiques of Medical Theories from the Perspective of the Socially
Marginal ized

My conception of objectivity requires that medical theorists invite and respond
appropriately to criticism of their work. That entails, amongst other things, that they
engage with and respond to critiques of medical theories that have been constructed
from the perspective of disenfranchised groups. Longino also posits this requirement
as part of her notion of objectivity. She justiﬁes it on the grounds that because
background assumptions and values motivating and embedded in theories tend to be
invisible to the members of the community that generates them,259 in the interest of
critically questioning them and bringing them to light, the scientiﬁc community ought
to engage in a dialogue with those with alternative viewpoints.260 Longino identiﬁes
feminists of different orientations and members of various other marginalized groups
as those with an alternative perspective who ought to be part of that critical inquiry.
Their involvement in critiquing scientiﬁc theories has the potential to change radically

the nature of scientiﬁc inquiry:

 

2’"In fact, acceptance of those assumptions may even be a precondition for membership in those
communities.
260Longino, SPK 111-2.

115

The feminist intervention I imagine will be local, that is, speciﬁc to a particular
area of research; they may not be exclusive, that is different feminist
perspectives may be represented in theorizing; and they will be in some way
continuous with existing scientiﬁc work. The accretion of such interventions,
of science done by feminists as feminists, and by members of other
disenfranchised groups, has the potential, nevertheless, ultimately to transform

the character of scientiﬁc discourse.261

While Longino contends that the socially disenfranchised are more likely than those
who are part of the dominant group to see background assumptions and values shaping
theories, she does not provide a detailed account of why that is the case. I believe
Carlo F ilice's work is somewhat illuminating in that respect. He has argued that by the
time one reaches adulthood in any society that is not utterly closed, one is exposed to
alternative values and that all of us have moments of doubt about the account of social

reality that is presented to us from childhood.262

He contends one has a moral duty to
explore those doubts.263 While Filice's intent is to make the case that all of us (both
those who are members of the dominant group and those who are socially
marginalized) have a duty to be reﬂective about the account of the world that society
presents to us, his argument could be used to explain why members of disenfranchised

comunities are better positioned than those who are privileged in a certain society to

recognize the dominant cultural values as oppressive. Presumably, members of

 

26'Longino, SSK, 193-4.
2"zCarlo Filiee. 1990. "On the Obligation to Keep Informed about Distant Atrocities" in Human Rights
Quarterly, Vol.12, 397-414.

3 However, he is silent about why that duty exists (more on this later).

116

marginalized groups by virtue of their social marginality have more reasons to
question the dominant, oppressive paradigm than those who hold positions of power
and privilege in that social order. Thus, in conjunction with others who are similarly
situated and dissatisﬁed with the status quo, they can create an alternative vision of
reality (that is, imagine the world otherwise than it is). In that reality, they are not
oppressed. Whether all members of disenfranchised groups are able to or chose to
pursue that option is an issue I discuss later (in the Critical Perspective Objection
section).

Although I endorse Longino's strategy, for the sake of clariﬁcation, I want to
add two qualiﬁers to my proposal.264 The kind of critique about particular medical
theories that I am interested in fostering has to, ﬁrst, recognize that medicine is about
providing accounts that are open to corroborations or disconﬁrrnation empirically. For
instance, the critique that 1 construct (in chapter three) of R.V. Short's theory' gendered

use of the theory of evolution265

is consistent with this criterion but a critique that takes
issue with his use of the theory of evolution on the grounds that it renders redundant
the notion of a supernatural creator is inconsistent with that criterion. Second, the
critiques of medical theories constructed from the perspective of disenfranchised
communities ought to assess medical theories on the basis of the values embedded in
them as well as their epistemic merits (such as explanatory scope, predictive success,

interenal coherence and consistency, compatibility with credible theoretical paradigms

of other disciplines, etc).

 

2("’1 believe that Longino would approve of these criteria as they are consistent with her position even
though she does not articulate them as such.
26’sn ' ' h f l

ort uses 1t to argue that women ought to conform to the reproductlve norm for ot er ema e
primates but makes no such parallel claim about men;s reproductive physiology (see chapter 3, section
3.2).

117

I espouse those two criteria because the success of medicine can be attributed
to them in no small degree. While the critical dialogue I envision occuring between
medical theorists and marginalized communities is meant to be revolutionary in certain
regards, it is intended to be respectful of those aspects of medicine that have a proven
track record.

There are at least two objections that could be raised against my proposal. I
term them the "Critical Perspective Objection" and the "Epistemic Privilege

Objection." Below, I describe and respond to them.

5.2 The Critical Perspective Objection

It could be objected that my strategy appears to assume that all members of
marginalized groups will have a critical perspective on the background assumptions
and values shaping the theory under scrutiny. The argument could be made that that
supposition is not warranted because some members of marginalized comunities may
subscribe to any one of the following three problematic positions:
Position A: Persons who subscribe to this view regard the epistemic success of a
particular theory to be evidence that it is the one and only true unbiased account of the
phenomenon at issue, untainted by any human concerns, interests, or contextual
values. For instance, on the basis of the empirical adequacy of Short's menstruation-as-
pathology theory, some women may believe that it is the one true value-free account
of human female reproductive physiology.
Position B: Those who are committed to this position uncritically accept the

oppressive dominant cultural values as the "right" values even though, unlike Group A,

118

they are not committed to the idea that the epistemic success of a certain theory is
evidence of it being the one true, value neutral account of the phenomenon under
consideration. For instance, some women may uncritically accept the sexist values
motivating and embodied in Short's menstruation theory as good values, even though
they recognize that the epistemic merits of that theory does not mean that it is the one
true value neutral account of menstruation.

Position C: Those who hold this position may believe that the dominant contextual
values shaping particular medical theories contribute to epistemic success. For
instance, they may believe that sexist values are at least in some part responsible for
the predictive and explanatory success of that theory relative to that of other

theories.266

5.3 My Response to the Critical Perspective Objection

I do not consider this objection to be a threat to my notion of objectivity;
speciﬁcally, the proposal that members of marginalized groups be invited to critique
medical theories. Rather, I read it as an opportunity for me to clarify my position. I
believe positions A, B, and C are problematic and have the potential to undermine the
kind of critical dialogue about medical theories that my notion of objectivity aims to
foster. Below, I explain my reservations about them.

My concern about those who subscribe to position A has nothing to do with
their peripheral social position and everything to do with their concept of theory. The

notion of theory they subscribe to is problematic for the following two reasons:

 

2""1 owe this point to Professor J. Nelson.

119

1. The assumption that a particular epsitemically successful theory is the one, true
account of the phenomenon at issue, unmediated by the social, political, and ethical
values of those that constructed them is not warranted. I argued in chapter two that
theories are representations (or models) of the world that necessarily reﬂect the
interests of the communities that constructed them. Thus, a theory's epistemic success,
including empirical adequacy, cannot be considered evidence that it is the one and
only true unbiased account of the phenomenon under consideration.

2. Assuming that theories reﬂect the interests of the communities that created
them and given that theories are underdetermined by data (i.e., the same set of data
can provide support for different theories) and given that competing theories may have

267 no one theory, regardless of its epistemic

varying degrees of epistemic success,
merits, can be considered the one true value-neutral account of the world.

It could be objected that this is a set-up for a free fall into relativism. But I do
not believe that the form of theoretical pluralism that I have argued for has to lead to
that conclusion. Given that theories are motivated by and reﬂect different interests and
concerns, different, and even incompatible, empricially adequate theories can be

regarded as responses to different cognitive needs and interests of various

communities:

To say that there may be irreconcilable but coherent and empirically adequate

systems for accounting for some portion of the world is not to endorse

 

2“For example, suppose there are two theories, X and Y. Theory X might be simpler than theory Y,
while the latter is coheres better with the credible theoretical paradigms of other disciplines than theory
X.

120

relativism but to acknowledge that cognitive needs can vary and that this

variation generates cognitive diversity.268

Aside from having reservations about those who subscribe to position A,269 I also have
serious concerns about the kind of contribution that those who subscribe to position B
would be capable of making in terms of the kind of critique they could offer of
particular medical theories. Nancy Hartsock and a host of other standpoint theorists
have argued that members of socially marginalized groups are better situated than
those who are dominant within a particular oppressive social framework to see it for
what it is. But that vision "must be struggled for and represents an achievement which
requires both science (and education) to see beneath the surface of the social relations
in which all are forced to participate..."270 Members of disenfranchised communities
who have unquestioningly and unreﬂectively accepted the version of social structures
and relations that was presented to them, such as women who believe patriarchal
values are good, cannot be relied on to provide the kind of critical contribution that the
interaction between the medical theorists and marginalized groups is meant to
generate. It is intended to make theorists aware of the contextual values shaping their
work and to encourage them to question those norms.

I also ﬁnd position C troubling because of its endorsement of oppressive
values and the assumption that those values are responsbile for a certain medical

theory's epistemic success. Given that medicine is an activity is about fostering human

 

mLongino, SPK, 113.

269It must be acknowledged that Position A is not a position that only members of marginalized
communities may hold. Those that are part of the dominant group(s) may hold it too.

270Hartsock, Nancy. 2004. "The Feminist Standpoint: Developing the Grounds for a Speciﬁcally
Feminist Historical Materialism" in The Feminist Standpoint Theory Reader: Intellectual and Political
Controversies edited by Sandra Harding. Routledge. 37.

121

well-being, rather than the well-being of particular groups at the cost of other groups,
position C is ethically untenable.

Although I have serious concerns about the ability of those members of
marginalized communities who are committed to positions A, B, or C to make the
kind of contribution to the critical dialogue between the disenfranchised and medical
theorists about medical theories that I envision, I do not believe that they ought not be
part of this dialogue. My reason for not excluding them is that they could provide
critical stress to the critiques of medical theories developed by the disenfranchised
who do not unquestioningly accept the dominant value system and who are theoretical
pluralists. That kind of stress could result in better critiques of medical theories than if
those critiques were not subject to any kind of scrutiny at all?”

Those who take issue with my notion of objectivity (speciﬁcally, my strategy
of critical dialogue between medical theorists and members of marginalized groups)
could also object to my position on the grounds that I have not accounted for the fact
that only some from those groups struggle to "see beneath the surface of the
(oppressive) social relations in which all are forced to participate."272 Given their
social marginality, it would seem that all members of that community are equally well-
positioned to "see" through oppression.

I believe that while it may appear that all members of disenfranchised groups
are equally well-situated to question the dominant paradigm, a number of factors
determine which of them develop a critical consciousness. The following is a list of

some of those factors:

 

27'1 owe this point to Professor .1. Nelson.

272Hartsock, Nancy. 2004. "The Feminist Standpoint: Developing the Grounds for a Speciﬁcally
Feminist Historical Materialism" in The Feminist Standpoint Theory Reader: Intellectual and Political
Controversies edited by Sandra Harding. Routledge. 37.

122

1. The existence of multiple forms of oppression and the nature of interaction
between them in a particular society may play a role in determining whether the
disenfranchised recognize as unjust their treatment and engage in collaborative
resistance and emancipation projects. Depending on where particular members of a
marginalized group are located within the intersecting webs of oppression, their ability
to establish alliances with other disenfranchised persons may be compromised or
enhanced. For instance, in a patriarchal, capitalist society, women who have class
privilege may not view themselves as belonging to a marginalized group vis-a-vis their
sex because of the privileges afforded to them by class.273 Or even if they do recognize
themselves as oppressed by patriarchy, they may decide not to form alliances with
women who are working class in order to maintain their class privileges.
2. The political freedom (in a particular nation) that various members of
disenfranchised communities have to collaborate in critiquing the dominant oppressive
paradigm and constructing an alternate vision of life may also determine whether or
not members of marginalized groups are able to develop a critical consciousness. In
societies afﬂicted by multiple forms of oppression, some of the oppressed may be
better-positioned socially and ﬁnancially than others to take political action.274

This is by no means an exhaustive list. However, it identiﬁes some of the
crucial factors that determine why some, but not other, members of marginalized

groups recognize dominant oppressive cultural values for what they are.275 Thus, it

 

273This is a grossly simpliﬁed example. In real life, things are much more complicated given that
multiple forms of oppression may be interconnected.

27"The political freedom afforded to the marginalized may also determine their exposure to alternative
world views. That, in turn, determines whether they are able to "see" (and to what degree) oppressive
values for what they are.

275An extended treatment of this issue lies beyond the scope of this project.

123

explains why not all members of disenfranchised communities are equally qualiﬁed to
be part of the kind of critical dialogue with medical theorists that I espouse.
l have argued that the Critical Perspective Objection is not a defeater argument

against my position. Now, I consider another objection to my proposal.

5. 4 The Epistemic Privilege Objection

It could be argued that my strategy is impractical because it offers no way of
adjudicating between different, possibly incompatible, analyses members of
disenfranchised groups may provide of the values motivating and embedded in
particular theories. Consider the following scenario: After reading the analysis of the
two menstruation-as-pathology theories that I provide in chapter three, a Marxist (a
member of a marginalized group in a capitalist society such as this one) could argue
that the two theories are fundamentally motivated and shaped by the capitalist
concerns of rich industrialized nations that see the growing populations in non-
industrialized, natural resource rich, developing nations as a threat to their ability to
secure raw materials for their industries. Alternatively, upon reviewing my analysis of
the two menstruation theories, a feminist might argue that the theories are essentially
rooted in and deﬁned by a patriarchal world view.276

Which one of the two competing analyses ought medical theorists accept and
use to guide their work? After all, depending on the one they decide to follow, they

would have to make different moves in terms of revising their hypotheses and research

agendas. If they accept the Marxist analysis, they would have to re-consider their

 

276This should not be read as the feminist analysis of the two cases; it is merely a hypothetical posit for
heuristic purposes.

124

commitment to the idea that overpopulation in the global South is the cause of poverty
and a threat to global stability. Acknowledging that capitalism run amok is a key cause
of global poverty would mean they might have to signiﬁcantly change their research
project, if their primary motivation is to end poverty. Alternatively, accepting the
feminist analysis, among other things, would mean revising some of the foundational
hypotheses of their menstruation theories because they are gender biased.

Given that both analyses have merit and given that there are serious
consequences depending on which of the two competing analyses they accept, should
medical theorists decide between them by tossing a coin? No, that would be wrong.
Such weighty decisions ought not be made in a ﬂippant manner and it is demeaning to
the two analyses at issue. Thus, it could be argued, unless my proposal for a critical
dialogue between medical theorists and disenfranchised communities can offer an

appropriate protocol for resolving such dilemmas, it is not a tenable strategy.277

5.6 Response to the Epistemic Privilege Objection

This is a serious problem for me as well as for Longino (she espouses this
strategy too). Before I offer my response, I consider what she has to say about it as it
might be illuminating. Longino does not appear to have addressed this problem head
on (in Science as Socal Knowledge and other key works). But I believe she does
consider it a serious problem if a theory can't provide a guide for deciding between

competing claims. In fact, she rejects standpoint epistemology and psychodynamically

 

27“'Presumably medical theorists would want to decide between competing analyses because, given that

they do not have unlimited resources, they would have to make decisions about which projects to pursue
and which one's to revise.

125

based theories278 because they do not offer a method for deciding amongst the

competing analyses generated by those who are differently positioned and oriented:

The standpoint and psychodynamically based theories recommend certain new
positions and orientations as superior to others but fail to explain how we are
to decide or to justify decisions between what seem to be conﬂicting claims
about the character of some set of natural processes. On what grounds can one

social location or affective orientation be judged superior to another?279

Interestingly enough, Longino fails to acknowledge that her proposed strategy is
vulnerable to the same problem. But I believe it may be possible to craft a response on
her behalf using the notion of theories that she subscribes to and by drawing on her
commitment to theoretical pluralism. Longino is committed to a model theoretic
theory of theories (as opposed to the theory of theories as sets of propositions).280
According to her, theories are representational devices for modelling aspects of the
world. The adequacy of a theory is determined by two factors. First, its success in
mapping some subset of the relations or structures posited in the model onto some
portion of the experienced world.281 Second, its efﬁciacy in modelling those relations

282 As particular ethical and

or functions that are of interest to those that constructed it.
political values and interests motivate and are embedded in speciﬁc theories, each

theory is expressive of a different form of engagment with the world and indicative of

 

278Longino discusses Evelyn Fox Keller psychodynamically based theory to make her point.
279Longino, SPK,.109.

280Longino, SPK,114-5.

28'1.ongino, SPK,115.

282Longino, SPK,115.

126

"the partiality of each model in revealing some aspect of natural phenomena ..."283 It is
because Longino believes that a multiplicity of theories is a necessary consequence of
theories reﬂecting and being shaped by different human interests, and it is because she
holds that they reveal different aspects of the phenomenon at issue that she endorses
fostering the development of multiple theories, even those that are incompatible. The
multiple accounts and dialogue between their formulators "make possible the
reﬁnement, correction, rejection, and sharing of models."284

Given Longino's stance on theoretical pluralism, I believe she might not be
unduly troubled by the objection that she has not identiﬁed a strategy for deciding
between competing analyses that disenfranchised groups might provide of the
background assumptions and values at work in a particular medical theory. She would
probably argue that because each of their analysis offers different, partial insight into
the theory under scrutiny, they should all be allowed to ﬂourish.

Although I ﬁnd appealing the idea of encouraging the development of
multiple, possibly incompatible, analyses of theories, that approach might be regarded
as impractical by medical theorists, who, constrained by time and resources, would
want a deﬁnitive answer about which of the two (or more) competing analyses they
should use to determine which hypotheses should be revised and which ones should be
developed. If medical theorists, such as Short et al, are expected to take seriously the

analyses of marginalized communities about the background assumptions and values

shaping their work, they must be afforded a method for deciding between competing

 

283Longino, SPK, 116.

28"Longino, SPK, 1 I7. I am puzzled why Longino does not offer this as a solution to the problem of
epistemic privilege that she believes undermines standpoint theory and psychodynamically based
theories. I assume it is a case of an oversight on her part. Or it could be the case that she thinks that
standpoint theory and psychodynamically based theories don't have the resources within them to offer
this response (I owe this point to Professor Schwartzman).

127

analyses of their work by members of disenfranchised groups. Otherwise, they might
consider the critical dialogue with members of marginalized communities to be a futile
activity that cannot be translated into practice.

I believe that in some cases the solution might be to "encourage" those who
have provided competing analyses of the medical theory under scrutiny to collaborate
with one another. Each of them would be asked to attempt to resolve an aspect of the
theory (or the circumstances of its development) that lies beyond the scope of the tool
that they have used to construct their analysis. For example, fostering collaboration
between the Marxist and feminist would mean asking the Marxist to account for the
fact that R.V. Short holds that women's reproductive physiology ought to conform to
the evolutionary norm for non-human primates, whilst he makes no such demand of
men’s reproductive physiology.285 He/ she would have to do so using only class as the
axis of analysis. It would also entail asking the feminist to use only gender as a tool of
analysis to account for Frank Notestein's success in securing the support of the US
govenment for the Population Council's agenda at a time when the US was concerned
about the spread of communism in poor nations that were rich in natural resources and
had high birth rates (the worry was if communism spread in those nations, US
industries would not be able to procure the raw materials that they needed from those
nations- see chapter three).

The purpose of this exercise is to make the Marxist and the feminist realize
that neither gender by itself nor class by itself, as a tool of analysis, can provide a

satisfactory account of all aspects of the two menstruation theories. Ideally, as a result,

 

2” For instance, Short acknowledges that in contrast to the semen of males of other primate species
(with the exception of gorillas), the sperm of human males has a greater incidence of of abnormality)
resulting in high incidence of embryonic mortality in humans than in other primates, he makes no effort
to argue that that aspect of human male reproductive physiology must be considered an evolutionary
aberration that is a pathological condition.

128

 

they would come to the conclusion (as I do in chapter three) that the two menstruation
theories are shaped by multiple forms of oppression, including sex and class,
interacting in complex ways with one another. That realization might lead them to
collaborate to create an analysis of the menstruation theories that covers more ground,
and thus, has more epistemic merit than their individual accounts. On the basis of that
joint endeavour, they could make suggestions to medical theorists about how they
should revise and re-conceptualize their theories and research program. In the best
case scenario, they would make at least the following three recommendations to Short
et a1:
1. They ought to re-evaluate their commitment to the idea that poverty is caused
solely or even primarily by high birth rates in developing nations. Instead, they should
recognize that capitalism run amok, colonialism, poorly planned structural adjustment
programs, unjust trade agreements, civil war, and corruption are responsible in no
small part for those miseries.
2. They should rethink their advocacy of menstrual suppressants as the cure for
anemia in developing nations. There is good evidence that hookworm disease and
malnutrition are primary causal factors for anemia amongst poor children, women, and
men in developing nations (see discussion in chapter three).
3. They ought to reconsider their arguments construing menstruation as an
evolutionary aberration that is pathological because it is under girded by gender biased
assumption about women.

This approach of "encouraging" collaboration between different members of
marginalized communities is a strategy that medical theorists could use in some cases

to resolve the problem which one of two (or more) competing analyses of the values

129

shaping their work they should give epistemic privilege. Ideally, the disenfranchised
would be willing to participate in such collaborative exercises because of a desire to
oppose and eradicate oppression not just for the group that they are part of but also
other populations that are subjugated.

However, I have to admit that there is no guarantee that it will work in every
situation. The possibility exist that in some cases, a particular disenfranchised group
using a certain tool of analysis, say sex, will be able to account for the phenomenon at
issue just as well as another marginalized group that employs another tool of analysis,
say class. That would mean medical theorists would have no substantial way of
deciding which analysis to give privilege.

In light of that limitation of my approach, medical theorists, such as Short et a1,
and philosophers of medicine, such as Boorse and Engelhardt, might balk at the
prospect of using it. But I do not believe my strategy's limited scope jusitiﬁes its
wholesale rejection. Rather, given that it can be fruitful in at least some instances and
given that there isn't a viable alternative for identifying values encoded in medical
theories, I believe medical theorists should adopt it.

Having adressed two objections to my notion of objectivity, now I close the

dissertation.

5. 6 Conclusion
In the interest of rendering transparent my motivation in undertaking this
particular project, I delineate the actual trajectory of my inquiry in the form of a

narrative. The dissertation chapters are not organized in that sequence because the

130

actual path of my research, including the process of formulating my notion of
objectivity, was contingent, circuitous, and complicated.286

I began thinking about the issue of the objectivity of medical theories while
taking a graduate level seminar in medical anthropology. I was quite impressed by
Emily Martin's careful and insightful analysis of sexist medical theorizing about
women's reproductive physiologym Reading it also made me curious about the
characterization of species typical aspects of women's reproductive physiology in
obstetrics textbooks. Whilst perusing a few textbooks in the library, I came across
Williams Obstetrics. I found that over a period of two decades and in various editions
of this standard US textbook, the editors of this work had consistently categorized
women's periodicity as a pathological condition that necessarily required medical
intervention. The arguments that they gave in support of their position were fallacious
and blatantly sexist. As someone opposed to sexism, and oppression in general, I
found that very troubling.

Delving deeper into their theory, I realized that they had appropriated a good
bit of it from R.V. Short's work on menstruation. I found Short's theory to be infected
with the same sort of sexism, only it was much worse. He believed that women's
reproductive physiology ought to conform to that of non-human female primates while
making no such analogous demand of men. Short too appeared to be blind to the
values shaping his work. Interestingly enough, he also identiﬁed himself as concerned
about women's well-being. Moreover, I believe he too would consider his theory to be

an objective account of women's reproductive physiology.

 

2""Although I have argued in the dissertation that all theories have contextual values, I believe a similar
argument could be made for concepts too. Though making that case lies beyond the scope of this
project, by describing the concerns and concrete circumstances that shaped my notion of objectivity, I
pagovide an instance in support of the claim that concepts have values too.

Martin, Emily. 1992. The woman in the body .' a cultural analysis of reproduction. Beacon Press.

131

As I struggled to make sense of all of that, I perused Short's other publications.
I saw a connection emerge between his fears about population growth, his
categorization of menstruation as a disease, and his endorsement of menstrual
suppressant contraceptives as the treatment of choice for that disease. His theory
appeared to have been inﬂuenced by a host of values. Some of them, such as sexism,
were embedded in the hypotheses of his theory, whilst others, such as racism,
populationist, and nationalist concerns, were external to it (i.e., they were not located
in the theory proper but appeared to have inﬂuenced his decision to advocate
menstrual suppressant contraceptives as the preferred treatment for menstruation).
Curious whether the populationist, racist, and nationalist worries infecting Short's
work were an idiosyncratic bias or a culturally pervasive phenomenon, I researched
the issue of population growth in the UK during the 19605 and 19705. I realized that
the values shaping his work mirrored the social and political concerns of the dominant
population of Britain (lining that era.

Whilst developing that analysis, I was asked to contribute to an anthology on
menstruation. The editor wanted me to expand my paper on Short and Williams
Obstetrics to include a discussion of the then newly published Is Menstruation
Obsolete? I found that Elsimar Coutinho and Sheldon Segal's theory medicalizing
menstruation seemed to have been motivated and shaped by the same cluster of values
that appeared to have inﬂuenced Short. There were also other striking parallels
between them. Coutinho and Segal too identiﬁed themselves as concerned about
women's well-being, all the while espousing fallacious and patently sexist arguments.

They too, I believe, regarded their account of menstruation to be objective.

132

As a bioethicist, was curious to see how Christopher Boorse and Tristram
Engelhardt would respond to Short eta1.'s work. I realized that while Boorse holds that
theories of disease ought to be objective (i.e., non-normative), his conception of
disease is such that he would accept Short et al's theories categorizing women's
periodicity as a disease, provided they could make the argument that it compromised
women's ability to reproduce and survive/7'88 In contrast to Boorse, Engelhardt
acknowledges that all theories of disease are value laden constructs. But on a certain
reading of his notion of disease, it would seem that he would, too, support Short et al.'s
classiﬁcation of menstruation as a pathological condition.289

While trying to make sense of Boorse's and Engelhardt's (possible) responses
to Short et al.'s theories, I realized that Boorse's stance (that theories of disease ought
to be value free and that good theories of disease are value free) was predicated on a
fairly strong commitment to the logical positivist conception of objectivity.290 (He, of
course, does not acknowledge that.) Logical positivists, such as Hempel, believed
theories could be objective (i.e., value neutral). They claimed knowledge could be
objective if it had been "intersubjectively veriﬁ[ed], independently of individual
opinion or preference, on the basis of data obtainable by suitable experiments or
observations.”29' The assumption underlying that notion of objectivity is that the
presence of values within a theory exerts a distorting inﬂuence, marring its ability to
account for what is out there. The logical positivists held that peer review guaranteed
objective knowledge because (they assumed that) statements that were laden with

values would not pass the test of intersubjective veriﬁcation.

 

288See chapter four.

289See chapter four.

290Whether Engelhardt is committed to logical positivism to the same degree is arguable (see chapter
four).

29'Hempel,l965, 141. See also Hempel, VOS, 374 and 380-1.

133

Reﬂecting on the logical positivist notion of objectivity, I realized that Short,
the editors of Williams Obstetrics, Coutinho, and Segal also appeared to subscribe to
that notion (although they do not identify themselves as such). They too believed that
it was possible for theories to be value free. They apparently held that theories that
passed the test of peer review (or more precisely, intersubjective veriﬁcation) qualiﬁed
as value neutral. As their menstruation-as-pathology theories had passed that test (i.e.,
the various hypotheses constituting their theories had been intersubjectively veriﬁed),
they believed they were value free.

The logical positivist epistemology, including the notion of objectivity that it
endorsed, has come under heavy ﬁre in the last few decades. In the interest of
deve10ping a critique of that conception of objectivity, I turned to the works of critics
of logical positivism. I was particularly impressed by Helen Longino and Lynn
Hankinson Nelson analyses. Their critiques addressed the issue of gender bias in the
sciences and were based on close textual analysis.292 However, while I found much
that was admirable about their work, I also realized that their analyses were ﬂawed in
certain crucial respects.293

Longino made a compelling argument against the logical positivist conception
of objectivity. She argued that because the background assumptions mediating the
relationship between hypotheses and evidence could be value-laden, the logical
positivists were not justiﬁed in assuming that the intersubjective veriﬁcation of
hypotheses guaranteed value free theories. The problem with Longino's argument was

that it did not categorically refute the possibility of value free theories. It allowed for

 

292Nelson's engagement with logical positivism is indirect in the sense that she develops some of
Quine's work, who has formulated a number of devastating critiques of logical positivism.
29’ See chapter two.

134

the possibility that there could be theories that are value free. Such theories would
have concepts, claims, or background assumptions that were not value laden.

Analyzing the limitations of Longino's critique, I realized she needed a
different sort of argument to categorically refute the logical positivist notion of
objectivity. To that end, drawing on Lynn Hankinson Nelson's work on, ﬁrst, the deep
connection and interdependence of scientiﬁc theories and ordinary language, and
second, the communal nature of knowledge building practices, I argued that any and
all theories are value laden. That argument is a more effective reﬁrtation of the
assumption underlying the logical positivist notion of objectivity- that theories can be
value free- than the one that Longino formulates. Using it, I categorically undermined
any effort on Short et al.'s part to argue that their menstruation-as-pathology theories
were value-free. I also constructed an alternative conception of objectivity.

I hold objectivity is a stance whose adoption entails, amongst other things, that
all knowledge construction activities are social, value laden. Assuming that stance also
entails placing a premium on critical dialogue about medical theories and research. My
notion of objectivity differs from the one that Longino constructs. She contends that
objectivity is a "characteristic of a community's (critical) practice of science."294 That
practice requires that, ﬁrst, there are recognized public venues for criticism, second,
there are shared epistemic and social standards for assessing scientiﬁc claims, third,
the scientiﬁc community responds appropriately to critiques that have merit, and
fourth, intellectual authority is shared equally and not afforded only to those with

social and political power.295

 

29"Longino, SPK, 74.
29’Longino, SPK, 76-9.

135

I ﬁnd Longino's account of objectivity as a critical practice problematic. I
believe objectivity ought to be conceptualized as a practice based on certain principles.
The principles at issue are those that deﬁne the nature of medical inquiry. Some of the
key principles are as follows:

i. Scientiﬁc and medical inquiry aims at constructing empirically veriﬁable
accounts of phenomena.

ii. All theories are value laden.

iii. One can only know as a member of an epistemic community.296

Conceptualizing objectivity purely as a critical practice, without
acknowledgment of these principles, appears to invite wrong headed theories and
critiques. For instance, someone like Short might think that it is possible for him to
construct a value neutral theory, or some might think that creationism qualiﬁes as a
scientiﬁc theoretical alternative to the theory of evolution. It is in the interest of

preventing such misunderstandings that I argue for conceptualizing objectivity as a

 

296Longino would ﬁnd this principle unacceptable because she rejects the idea (borrowed from Lynn
Hankinson Nelson) underlying it- that epistemic communities are the primary knowers (see Fate of
Knowledge 146). Her reason for rejecting is the same one that Heidi Grasswick articulates. Grasswick
claims that Nelson's attribution of primary epistemic agency to communities deprives individuals of any
cognitive or doxastic autonomy, which bars the possibility of any change or growth in knowledge.

I believe Grasswick and Longino's critique of Nelson misses the mark because it does not take
into account the interaction between multiple epistemic communities that is at the heart of Nelson's
theory. Nelson's claim that epistemic communities are primary knowers does not preclude the
possibility of change or growth in knowledge. As individuals are members of multiple epistemic
communities simultaneously, and given that these communities go in and out of existence, individual
members who are part of those communities carry knowledge between communities. The knowledge
brought by a new community member could cause that community to re-evaluate its conception of the
world, resulting in a change in its knowledge. This interaction between communities, I believe,
accounts for change and growth in knowledge. Also, Grasswick and Longino's claim that individuals
have no doxastic or cognitive authority is misguided because there is nothing in Nelson's account that
bars individuals from exercising epistemic agency. An individual's decision to join or leave an
epistemic community could be an exercise of his/ her doxastic or cognitive agency.

136

stance, whose adoption entails acknowledging the kind of activity scientiﬁc and
medical inquiry is as well as a commitment to critical dialogue about theories.297
Given that I deﬁne being objective as a particular stance that knowers may adopt, my
response to the question motivating this project -"are medical theories objective?" - is
that theories cannot be considered free of contextual values. Theories reﬂect the values
and interests of the communities that constructed them, thus, no medical theory can be
value free. While I hold that no medical theory is value free, I do not mean to suggest
that all value-laden medical theories should be accepted uncritically. Moreover my
notion of objectivity does not entail a categorical prohibition against the construction
of medical theories pathologizing aspects of physiology unique to women, men, or
humans. But what it does require is that medical theorists should recognize their work
as a value-laden activity and that they should be more critical and reﬂective about their
work than they are currently. To that end, the strategies that I delineate for identifying
values shaping theories should be more useful than the ones endorsed by the logical
positivists.298

While I have answered the question that prompted this project, there are other
questions that this dissertation has raised that I have not been able to address. Below, I
sketch the three that interest me the most.

Earlier in this chapter, I noted that not all members of marginalized
communities can be expected to have critical perspective into the dominant social

system. The question that I did not address is as follows: What could be done, both

 

297Although my position may seem to be similar to Longino's, it is different form hers in a crucial
respect. While 1 (drawing on Nelson's work) make a rigorous epistemological argument for the claim
that all theories have values, Longino does not make such an argument.

2"'"Of course, I do not hold that any and all contextual values should or can be eliminated. Theories with
oppressive values should be revised or discarded in favor of those theories with emancipatory values
with appropriate epistemic merits. Moreover, given the nature of human epistemic enterprises, I
contend all theories have contextual values.

137

nationally and internationally, to create conditions that would allow all members of
marginalized groups develop critical consciousness?

Another question that remains unanswered is as follows: Given that the work
of feminist philosophers of science and epistemologists (including the work I do here)
has much to offer to philosophy of medicine as well as medical theorists, what can be
done to introduce them to it and to engage with it?

The third and ﬁnal question that I believe deserves attention is based on Carlo
Filice's work. He contends that all of us have a duty to question the account of the
world that society presents to us. However, F ilice does not explain why that obligation
exists.299 I believe that is a question worth thinking about.

I close with these questions because they are of particular interest to me as they
have to do with making theory relevant to practice and so I view them as potential

future projects.

 

299Earlier, I discussed why the disenfranchised might be more likely to question the dominant account
of reality than those who are socially privileged but 1 did not take up the question why all of us have a
duty to do so.

138

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